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American Association for Hand Surgery

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An Aesthetic Evaluation of Surgical Incisions in the Treatment of Trigger Fingers: the Patient and Surgeon Perspective
Logan A Morin, BS1, Mada Hamwi, BS1, Michael VonBorstel, BA1 and Andre Ivy, MD, MS2, (1)Midwestern University, Downers Grove, IL, (2)Dupage Medical Group, Lombard, IL

Introduction
Trigger finger release is a common and efficacious surgical procedure performed through either a longitudinal or oblique incision in or near the distal palmar crease. Both approaches have similar functional outcomes, safety profiles, and scar quality post-operatively(1). In this study, we evaluate the patient and surgeon aesthetic preference regarding these incisions in digits 2-5.
Methods
413 patients and 38 fellowship-trained hand surgeons were queried via an online survey. Each participant was shown sequential pairs of stylized hands with either a longitudinal or oblique incision and were asked to indicate which they would prefer if they had surgery. Surgeons were additionally queried regarding their customary incision, reasons for use, and willingness to change if informed of a patient preference.
Results
The majority of patients preferred oblique incisions (76%) over longitudinal incisions (15%) with 9% having no preference (P<0.0001). Incision preference decreased with age, and trended toward oblique in women and younger patients. Among patients with a prior trigger finger release, 78% with oblique incisions indicated they would choose the same incision again while only 54% with longitudinal incisions indicated they would choose the same incision (P<0.0001).
The majority of surgeons preferred oblique incisions (52%) over longitudinal incisions (33%) on their own hand with 15% having no preference. The majority of surgeons were oblique-users (58%), most commonly citing cosmesis and familiarity as the reason. 40% of surgeons were longitudinal-users, most commonly citing familiarity and ease as the reason. Oblique-using surgeons indicated a preference for oblique incisions on their own hand 76% of the time, while longitudinal-using surgeons indicated a preference for longitudinal incisions on their own hand only 63% of the time (P=0.032). Regarding changing their approach if patients preferred the opposite incision, 55% stated "maybe", 29% "yes", and 16% "no" with slightly more longitudinal-users choosing "no" (20% vs 13%).
Conclusions
The majority of patients and surgeons preferred oblique incisions over longitudinal incisions. Patients who previously had an oblique incision were significantly more likely to choose it again compared to patients who previously had a longitudinal incision. Longitudinal-using surgeons were significantly less likely to prefer their own incision on themselves and slightly less willing to change than oblique-users. Without sufficient evidence to support superior outcomes of longitudinal incisions, the aesthetic preference of oblique incisions should be taken into consideration.


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