CPT® Code 64886

A nerve graft procedure involves the surgical repair of a damaged nerve in the head or neck using a graft that is longer than 4 cm. This technique is employed to facilitate a tension-free repair of the injured nerve, which is crucial for restoring nerve function. The process begins with the exposure of the injured nerve, allowing the surgeon to assess the extent of the damage. Any necrotic or damaged tissue is carefully debrided to prepare the site for grafting. To evaluate the function of the nerve, additional nerve testing and monitoring may be performed, which can provide valuable information regarding the nerve's condition.

Once the injury is assessed, the healthy segments of the nerve, both proximal and distal to the injury, are meticulously dissected free from surrounding tissues. The length of the required nerve graft is then determined based on the gap that needs to be bridged. The graft is harvested from a donor nerve, which is also exposed and dissected free of surrounding tissue to obtain the desired length. After the graft is harvested, it is sutured to the ends of the severed nerve. The surgical technique for this anastomosis can vary, with options including epineural and perineural repairs. In an epineural repair, sutures are placed in the outer layer of the nerve (epineurium) to secure the graft to the nerve ends. Alternatively, a perineural closure involves identifying and suturing individual fascicles of axons, which are the functional units of the nerve. This meticulous approach ensures that the nerve is repaired in a way that maximizes the chances of restoring its function. Finally, the overlying soft tissues and skin are repaired in layers to complete the procedure.