A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications

Abdoli, Abbas; Asadian, Majid; Banadaky, Seyed Houssein Saeed; Sarram, Rabeah

doi:10.1186/s13018-021-02566-4

Cited by 5 publications

(6 citation statements)

References 46 publications

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“…Many cadaveric studies also revealed that percutaneous release did not lead to adjacent organ injury and was safe and accurate [1][2][3], and other several groups also recommended percutaneous release over conventional open resection. [7] While percutaneous release was not associated with adjacent organ injuries in any other studies [8], it has been observed to cause small surgical wounds with fewer complications (like bowstrings) as compared to open technique [13] In randomized controlled trials where the trigger finger recurrence rate after percutaneous release was not significantly different…”

Section: Discussionmentioning

confidence: 95%

“…[6] Lately, HAKI knives modified from existing surgical instruments are used in the treatment of trigger finger, and the surgery is guided through ultrasound for safety. [7][8][9] The procedure is as follows: After administering local anesthesia to the digit affected by trigger finger, a needle is inserted just distal to the flexor crease where the A1 pulley is located. The bevel of the needle is oriented longitudinally with the tendon, and a longitudinal release of the A1 pulley is performed.…”

Section: Percutaneous A1 Pulley Releasementioning

confidence: 99%

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Serious Complications of the Percutaneous A1 Pulley Release: Case Reports and Literature Review

Lee,

Lee

et al. 2023

Arch Plast Surg

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Percutaneous A1 pulley release, which has been increasingly used to treat trigger fingers, has been widely established as a safe and simple procedure. Multiple studies have reported positive results of percutaneous A1 pulley release. In this study, however, we report cases of patients who developed complications after undergoing percutaneous A1 pulley release at local clinics. A total of six patients visited our hospital for infectious complications after percutaneous A1 pulley release. Various sequelae such as damage to normal structures, insufficient procedure, and tissue necrosis were observed during the exploration. A retrospective study was conducted to identify the cause and trend of the observed complications by instruments (HAKI knife or needle) etc. In the HAKI knife group, there was a tendency for damage to normal structures, while in the needle group, an insufficient release or serious soft tissue necrosis was observed. Based on these cases, our findings confirm the existence and characteristics of infectious complications following the percutaneous A1 pulley release. We further identify that the type of instrument used predicts the nature of complications. Thus, reliable and skilled performance of the procedure by experts is essential for safe treatment.

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Section: Discussionmentioning

confidence: 95%

Section: Percutaneous A1 Pulley Releasementioning

confidence: 99%

Serious Complications of the Percutaneous A1 Pulley Release: Case Reports and Literature Review

Lee,

Lee

et al. 2023

Arch Plast Surg

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“…Many studies have demonstrated that percutaneous A-1 pulley release is an effective and safe procedure in adult trigger thumb surgery [15][16][17][18]; however, the optimal treatment for pediatric trigger thumb is unclear. While the most commonly accepted methods are conservative (observation, exercise, and splint use) for low-level triggers, surgical release of an A-1 pulley is preferred for major cases that develop flexion rigidity.…”

Section: Discussionmentioning

confidence: 99%

“…Open surgery often requires an operating room, a surgical incision, and postoperative wound care; however, percutaneous release does not require hospitalization or surgery, and is relatively easier and faster. It has been reported that percutaneous A-1 pulley release is an effective and safe procedure in adult trigger thumb surgery [15][16][17][18]. Thus, this procedure is considered to cause insufficient A-1 pulley release and neurovascular injury risk, especially for young children [19].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous release for trigger thumb in children under local anesthesia

Çimen

Irgıt²,

Nami

2023

Journal of Pediatric Orthopaedics B

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Trigger thumb surgery can be performed through open surgery or percutaneous release. Open surgery often requires hospitalization, an operating room, a surgical incision, and postoperative wound care; however, percutaneous release does not require hospitalization or surgery, and is relatively easier and faster. We aimed to assess the results of percutaneous A-1 pulley release using local anesthesia without hospitalization for the treatment of pediatric trigger thumb. In this retrospective study, we included patients operated on between March 2013 and August 2020 with the diagnosis of trigger thumb. The percutaneous release under local anesthesia was applied to all the children by one orthopedic surgeon. All percutaneous release procedures were performed in outpatient clinic conditions. There were 183 children (218 thumbs) who were enrolled in the clinic. Eighty-seven patients were male (47.5%) and 96 were female (52.5%). The average follow-up duration was 5 years (1–8.5 years). Among the 218 trigger thumb cases, 211 were satisfactory (successful result rate 96.8%). Relapse was seen in only 3 thumbs in the early postoperative period. No patient experienced neurovascular deficit or infection. The percutaneous surgical release in pediatric trigger thumb treatment is a simple, minimally invasive procedure that can be done in an outpatient setting under local anesthesia. In addition, the procedure duration is short and has minimal complication rates and maximum patient satisfaction. Level of Evidence III.

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“…5 In 1958, Lorthioir 6 introduced a technique for the percutaneous release of the A1 pulley using a special cutting device. Since then, many studies have used different cutting devices for percutaneous release of the A1 pulley, such as a 21-Gauge Needle, 7 Stab Knife, 8 and so on. Recently, it has also been reported that the use of acupotomy percutaneous release of the A1 pulley in the treatment of trigger finger had achieved good results.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous A1 Pulley Release by Acupotomy (Needle-Knife): A Cadaveric Study of Safety and Efficacy

Yang¹,

Ma²,

Zhong³

et al. 2022

JPR

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This study was to assess the safety and effectiveness of ultrasound-guided percutaneous A1 pulley release by acupotomy on unembalmed cadavers. Materials and Methods: Sixty digits (from six cadavers, three male and three female) were split into two groups using stratified randomization. All procedures were completed by a single doctor with rich experience in ultrasound-guided treatment. In the acupotomy group, the A1 pulley was released under ultrasound-guided by a needle-knife; while in the needle group, the A1 pulley was released under ultrasound-guided by a 21-gauge needle. Two groups completed six thumbs and 24 fingers, respectively. Another anatomist, blinded to the two techniques, assessed the safety, including the minimum distance between the incision and the neurovascular; flexor tendon, neurovascular and A2 pulley injury or not. Completeness release of the A1 pulley was recorded as effectiveness. Results: No neurovascular or A2 pulley injuries were recorded. However, the incision of the thumb in both groups biased to the radial side (P <0.05), while the incision of the finger biased to the ulnar side (P <0.05). No significant flexor tendon injury was found, and only five cases (16.7%) had minor scratches in the acupotomy group; while in the needle group, 15 cases had minor scratches and lacerations occurred in three cases. The flexor tendon injury rate was 60%. Compared with the needle, ultrasound-guided acupotomy release is safer (P <0.05). The ultrasound-guided acupotomy technique was significantly more likely to result in a complete A1 pulley release compared to the needle technique (28 of 30 [93.3%] versus 11 of 30 [36.7%]; P <0.05). Conclusion: Ultrasound-guided percutaneous A1 pulley release by acupotomy is a safe and effective technique. When releasing the thumb by ultrasound-guided, be careful not to bias to the radial side to avoid neurovascular injury, while when releasing a finger, be careful not to bias to the ulnar side.

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A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications

Cited by 5 publications

References 46 publications

Serious Complications of the Percutaneous A1 Pulley Release: Case Reports and Literature Review

Serious Complications of the Percutaneous A1 Pulley Release: Case Reports and Literature Review

Percutaneous release for trigger thumb in children under local anesthesia

Ultrasound-Guided Percutaneous A1 Pulley Release by Acupotomy (Needle-Knife): A Cadaveric Study of Safety and Efficacy

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