CPT® Code 26357

Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, without free graft, each tendon

The CPT® Code 26357 refers to the surgical procedure for the repair or advancement of a flexor tendon located in zone 2 of the digital flexor tendon sheath, commonly known as "no man's land." This area is critical for hand function and is defined as the region between the insertion of the flexor digitorum superficialis tendon and the proximal A1 pulley, extending from the proximal end of the proximal phalanx to the distal end of the middle phalanx. Injuries to the flexor tendons in this zone can result from partial or complete lacerations, tears, or ruptures, which may severely impact a patient's ability to flex their fingers. The procedure coded as 26357 is specifically categorized as a secondary repair, which is performed more than two weeks after the initial injury. This contrasts with primary repairs, which are typically conducted within 24 hours of the injury unless complications such as gross contamination necessitate a delay of up to two weeks. During the surgical intervention, the tendon is accessed through a volar zigzag or lateral incision, with careful dissection of the surrounding soft tissues to protect vital neurovascular structures. The surgeon locates the distal and proximal ends of the severed tendon, which may require additional incisions if the proximal end has retracted. The repair involves approximating and suturing the tendon ends together, ensuring proper alignment and tension to restore function. This procedure is crucial for patients who have sustained significant tendon injuries, as it aims to restore the integrity and functionality of the flexor tendon, thereby improving hand movement and overall quality of life.