CPT® Code 26358

Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, with free graft (includes obtaining graft), each tendon

The procedure described by CPT® Code 26358 involves the repair or advancement of a flexor tendon located in zone 2 of the digital flexor tendon sheath, commonly referred to as "no man's land." This area is critical for hand function and is defined anatomically 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 can manifest as partial or complete lacerations, tears, or ruptures, necessitating surgical intervention for proper healing and restoration of function. The procedure is categorized as a secondary repair, which is typically performed more than two weeks after the initial injury, especially when primary repair is not feasible due to factors such as gross contamination of the wound. During the surgical process, the tendon is accessed through a volar zigzag or lateral incision, with careful dissection of soft tissues to protect surrounding 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. In this specific procedure, a free graft is utilized, which involves harvesting a tendon graft—often the palmaris longus from the distal forearm—and securing it to the affected flexor muscle at the wrist, then tunneling it to the appropriate attachment point. This method is essential for restoring the continuity and function of the flexor tendon in the hand.