Flexor Tenosynovial Fistulas in the Palm

Synovial Fistula as a Complication of Release of A1 Pulley for Trigger Finger

“…Naam mentioned intra-operative steroid injection, patients who had two or more surgeries in the same digit for trigger finger release, and patient who underwent extensive dissection in the first surgery as risk factors for wound complications in the palm [7]. In our study, the first patient has not presented any significant risk factor for the development of tenosynovial fistula, yet, the fistula has appeared.…”

“…Within which six patients had multiple surgeries for stenosing flexor tenosynovitis. Out of 15 patients, 4 patients had unsuccessful closure of the fistula [7]. Will et al described 1 patient with tenosynovial fistula out of 43 patients who had had 78 open trigger finger release by a single surgeon [3].…”

“…Synovial fistula (communication between a synovial or tenosynovial space and the external skin) in the palm is rare. It was described as a complication of fish fin injury, lacerations of the palm, pellet gun injury, and release of A1 pulleys for trigger finger [7]. Some studies showed a higher rate of wound complications, in patients who had intra-operative steroid injection, patients who had two or more surgeries in the same digit for trigger finger release, and patient who underwent extensive dissection in the first surgery [7].…”

Persistent spontaneous synovial drainage from digital flexor sheath in proliferative tenosynovitis: Two case reports and a review of the literature

“…Conservative treatment with immobilization for up to two weeks has been reported to be effective with synovial fistulas of the knee (10). Immobilization and antibiotics for flexor tenosynovial fistulas of the palm were not shown to be effective in the literature, although the conclusion is limited due to a low level of evidence (9). Immobilization was used in case 1 for a period of two weeks and both Patients with inflammatory arthritides, such as rheumatoid arthritis, may also be at higher risk for developing synovial fistulas (15,16).…”

“…Persistent synovial drainage through a patent communication between the flexor sheath and the skin has not been previously described in patients with severe proliferative tenosynovitis. There are two documented series reporting flexor tenosynovial fistula formation of the hand after injury or trigger finger release (8,9).…”