AAHS - A Non-Scalpel Technique for Ultra-Minimally Invasive Surgery: Percutaneously Loop Threaded Transection of the A1 Pulleys for Trigger Finger Release

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A Non-Scalpel Technique for Ultra-Minimally Invasive Surgery: Percutaneously Loop Threaded Transection of the A1 Pulleys for Trigger Finger Release
Danzhu Guo, MD; Danqing Guo, MD
BayCare Clinic, Green Bay, WI

Introduction: Traditional open A1 pulley surgical release of stenosing tenosynovitis (trigger finger) reported dissatisfaction rates of 15-26%. This study aims to develop an alternative, ultra-minimally invasive technique for improving the surgical procedure for trigger finger release.
Materials and methods: Using 20 fingers on four unembalmed cadaveric hands, one clinician utilized a piece of thread looped percutaneously under ultrasound guidance to transect the digital A1 pulley. A second clinician then dissected the cadaveric digits to observe for completeness of transection and for the presence of unintended trauma to the surrounding neurovascular bundle, flexor tendons, and A2 pulley.
Results: Eighteen out of twenty digits used topographic boney landmarks to determine proximal and distal boundaries of the A1 pulley and demonstrated complete transection of the A1 pulleys, following the use of two digits as pilot studies. In all cases, there was no anatomical disruption to the neurovascular bundle, flexor tendons and A2 pulley.
Conclusion: As opposed to traditional open surgical releases, the loop threaded transection of the A1 pulleys for trigger finger is safe, effective and ultra-minimally invasive surgery. This office based procedure includes benefits of no surgical incision and earlier return to work; as well as reduced risk of iatrogenic injury and reduced surgical cost. This study has shown encouraging promise for optimizing trigger finger release.

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