CPT® Code 64861

The brachial plexus is a complex network of nerves that originates from the spinal cord and is responsible for controlling both movement and sensation in the upper extremities, including the shoulders, arms, and hands. In contrast, the lumbar plexus, also known as the lumbosacral plexus, governs similar functions in the lower extremities, such as the hips, legs, and feet. Suture repair of the brachial plexus is typically indicated in cases of traumatic injuries, particularly those caused by sharp objects that penetrate the nerve tissue. During the procedure, the site of injury is surgically exposed and thoroughly explored to assess the extent of the damage. This exploration may involve debridement, which is the removal of damaged or necrotic tissue to promote healing. Intraoperative nerve function testing and monitoring may be performed as necessary to evaluate nerve integrity and function during the repair process. The actual repair of severed nerves can be accomplished using various techniques, including end-to-end closure, which is a common method for re-establishing continuity in the nerve pathway. The procedure involves careful dissection of the injured nerves from surrounding tissues, both proximal and distal to the injury site, to facilitate proper alignment and suturing of the nerve ends. The suture repair can be performed using an epineural technique, where sutures are placed in the outer layer of the nerve (the epineurium) to approximate the nerve ends without applying tension. Alternatively, a perineural closure technique may be employed, which involves exposing the individual fascicles of axons within the nerve and suturing them together based on their functional grouping. This meticulous approach ensures that the nerve's functional capabilities are preserved as much as possible. Each severed nerve in the brachial plexus is repaired individually, and the choice of technique may vary based on the specific nature of the injury and the surgeon's preference.