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

Oliver Kloeters, Dietmar J O Ulrich, Gijs Bloemsma, Claire I A van Houdt, Oliver Kloeters, Dietmar J O Ulrich, Gijs Bloemsma, Claire I A van Houdt

Abstract

Introduction: The 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 methods: Thirty 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.

Results: All 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.

Conclusion: There 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.

Keywords: A1 pulley release; DASH; Hand; Outcome; Scar tissue; Skin incision; Stenosing tenosynovitis; Surgical techniques; Trigger finger.

Figures

Fig. 1
Fig. 1
Schematic drawing of the three different incision techniques used in this study from D2 to D5
Fig. 2
Fig. 2
Representative picture of sonographic assessment for scar tissue. The white arrow indicates the triangular hypo-echoic scar tissue region
Fig. 3
Fig. 3
Distribution of operated digits (n = 32 digits)
Fig. 4
Fig. 4
DASH scores at different time points in mean ± SEM per group, comparing the baseline to postoperative time points; **significant difference of p < 0.01 and ***p < 0.001
Fig. 5
Fig. 5
a Mean DASH scores at different time points ± SEM per group; a significant difference between group 1 and 2, p < 0.001; b significant difference between group 2 and 3, p < 0.001; c significant difference between group 1 and 2, p < 0.05. b Relative differences (delta) of mean DASH scores over time, each delta comparing between two groups; *significant difference, p < 0.05, between groups 2 and 3 with a significant faster decrease for group 3; group 1 transverse in distal palmar crease, 2 transverse 2 mm distal from distal palmar crease, 3 longitudinal; ***p < 0.001
Fig. 6
Fig. 6
Volumes of scar tissue in mm3 (mean +SEM) per group; there were no significant differences between groups

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