Comparison of three different incision techniques in A1 pulley release on scar tissue formation and postoperative rehabilitation

Abstract

IntroductionThe optimal surgical approach for trigger finger release remains controversial in hindsight of postoperative rehabilitation as well as scar tissue formation. In this study, we comparatively evaluated the outcome of three different types of skin incision by employing the “Disability of the Arm Shoulder and Hand Score” (DASH) and by quantitative ultrasound measurements of scar tissue volume.Materials and methodsThirty patients (32 triggerfingers) were enrolled in this study and randomly assigned to one of three groups: incision placed (1) transversal in distal palmar crease, (2) transversal and 2 mm distal from distal palmar crease, (3) longitudinally over MCP joint without crossing the distal palmar crease. Patients characteristics were noted and DASH scores were retrieved at four time points, (1) preoperatively (baseline), (2) 1 month, (3) 3 months, (4) 12 months postoperatively. Scar volume formation was assessed by ultrasound at 3 months postoperatively in 28 patients.ResultsAll groups showed a significant reduction in DASH values at 3 and 12 months postoperatively when compared to their own baseline levels. Group 3 showed the fastest and most pronounced reduction in DASH values at 1 month. Scar tissue formation was almost 57 % increased in group 1 vs group 2 and 3, however, not significant.ConclusionThere is no clear benefit of one incision technique over another. However, based on scar volume parameters, the significant faster recovery in the first month and the surgical ease of exposure and wound closure inclines us to favor the longitudinal incision (group 3) in future patients.

Endoscopic Retrograde Approach for Trigger Finger Release: A Cadaver Study

“…In the open approach, an incision is made in the palm, most commonly at or slightly distal to the distal palmar crease, which violates the palmar fascia and causes great discomfort to patients. 10 , 11 We believe this pain is analogous to the tenderness experienced with open carpal tunnel release, which is lessened through use of a non-palmar incision during endoscopic release. 24 …”

“… 21 – 23 These symptoms may limit a patient’s hand use for weeks after surgery. 10 , 13 , 21 , 22 . In the open approach, an incision is made in the palm, most commonly at or slightly distal to the distal palmar crease, which violates the palmar fascia and causes great discomfort to patients.…”

“… 4 – 9 The described surgical techniques fall short in 1 of the 2 ways: they require an incision of the palm, and the underlying palmar fascia or the release is performed blindly. 3 , 10 , 11 …”

A prospective, randomized clinical trial of transverse versus longitudinal incisions for trigger finger release

“…During the course of our study, Kloeters et al (2016) published a prospective, randomized study comparing quantitative scar volume and clinical outcomes between three incision types for trigger finger release performed in 32 patients. They evaluated longitudinal, distally based transverse, and proximally based transverse incision types.…”

Surgical treatment of trigger finger? Longitudinal incision versus transverse incision?

“…yaptkları bir çalışmada; tetik parmak cerrahisinde 3 ayrı insizyon şekli denenmiş olup, sadece distal palmar çizgi üzerindeki transvers insizyonda skar dokusu gelişiminin daha fazla olduğu bulunmuştur. Onun haricinde herhangi bir farklılılık saptanmamıştır (13). Çalışmamızda ise 2 olguda belirgin skar dokusu oluşumu görülmüştür.…”