title: Comparison of three different incision techniques in A1 pulley release on scar tissue formation and postoperative rehabilitation.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Plastic Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GC, Nijmegen, The Netherlands. okloeters@gmx.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Kloeters
authors.affiliation: Department of Plastic Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GC, Nijmegen, The Netherlands.
authors.forename: Dietmar J O
authors.initials: DJ
authors.lastname: Ulrich
authors.affiliation: Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Gijs
authors.initials: G
authors.lastname: Bloemsma
authors.affiliation: Department of Plastic Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GC, Nijmegen, The Netherlands.
authors.forename: Claire I A
authors.initials: CI
authors.lastname: van Houdt
mesh_terms: D002921:Cicatrix / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications; D016896:Treatment Outcome; D052582:Trigger Finger Disorder / Q000601:surgery*
keywords: A1 pulley release; DASH; Hand; Outcome; Scar tissue; Skin incision; Stenosing tenosynovitis; Surgical techniques; Trigger finger