PRS AAPS Oral Proofs 2016
Don Hoang, MD,* Ann C. Lin, BS,* Anthony Essilfie, MD,† Alidad Ghiassi, MD,† Stuart Kuschner, MD,‡ Joseph Carey, MD*
From the *USC Plastic and Reconstructive Surgery, Los Angeles, Calif.; †USC Orthopedic Surgery, Los Angeles, Calif.; and ‡Hand Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif.
PURPOSE: Despite percutaneous trigger finger release (PTFR) success rates more than 94%, controversy remains over fear of neurovascular injury. We assessed the safety of blind versus sonographically guided [ultrasound (US)] first annular (A1) pulley releases performed on a perfused cadaveric model.
METHODS: On hundred twenty-four fingers/31 thumb percutaneous A1 pulley releases were performed on perfused un-embalmed cadavers (65 female, 90 male) and an 18-gauge needle. Forty-five fingers/thumbs were completed with US versus 110 without. Each digit was evaluated for A1 pulley release and neurovascular, flexor tendon, A2 pulley injury.
RESULTS: One hundred fourteen (74%) A1 finger and thumb pulleys were effectively released, and only 3 digits (one long, ring, and small finger each) were completely missed (2%). On average, 93% of A1 pulley length was released for all fingers. No significant flexor tendon injury was seen in any digit, although longitudinal scoring was found in 35 fingers (23% overall). No digital, radial or ulnar, artery or nerve was injured. The use of US for PTFR was not more likely to result in a complete pulley release compared with Blind PTFR (80% vs 72%; P < 0.26).
CONCLUSIONS: Both blind and ultrasound-assisted percutaneous releases of the A1 pulley can be performed safely and effectively for all fingers including the thumb. Perfusion of cadaver digits enhances surgical simulation for PTFR training, especially for in vivo identification of structures by US with Doppler flow.