title: Evaluation of Percutaneous First Annular Pulley Release: Efficacy and Complications in a Perfused Cadaveric Study.
abstract: OBJECTIVE
  Trigger finger is the most common entrapment tendinopathy, with a lifetime risk of 2% to 3%. Open surgical release of the flexor tendon sheath is a commonly performed procedure associated with a high rate of success. Despite reported success rates of over 94%, percutaneous trigger finger release (PFTR) remains a controversial procedure because of the risk of iatrogenic digital neurovascular injury. This study aimed to evaluate the safety and efficacy of traditional percutaneous and ultrasound (US)-guided first annular (A1) pulley releases performed on a perfused cadaveric model.
  
  
  METHODS
  First annular pulley releases were performed percutaneously using an 18-gauge needle in 155 digits (124 fingers and 31 thumbs) of un-embalmed cadavers with restored perfusion. A total of 45 digits were completed with US guidance and 110 digits were completed without it. Each digit was dissected and assessed regarding the amount of release as well as neurovascular, flexor tendon, and A2 pulley injury.
  
  
  RESULTS
  Overall, 114 A1 pulleys were completely released (74%). There were 38 partial releases (24%) and 3 complete misses (2%). No significant flexor tendon injury was seen. Longitudinal scoring of the flexor tendon was found in 35 fingers (23%). There were no lacerations to digital nerves and one ulnar digital artery was partially lacerated (1%) in a middle finger with a partial flexion contracture that prevented appropriate hyperextension. The ultrasound-assisted and blind PTFR techniques had similar complete pulley release and injury rates.
  
  
  CONCLUSIONS
  Both traditional and US-assisted percutaneous release of the A1 pulley can be performed for all fingers. Perfusion of cadaver digits enhances surgical simulation and evaluation of PTFR beyond those of previous cadaveric studies. The addition of vascular flow to the digits during percutaneous release allows for Doppler flow assessment of the neurovascular bundle and evaluation of vascular injury.
  
  
  CONCLUSIONS
  Our cadaveric data align with those of published clinical investigations for percutaneous A1 pulley release.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Don
authors.initials: D
authors.lastname: Hoang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Lin
authors.affiliation: Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Essilfie
authors.affiliation: Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Minneti
authors.affiliation: Department of Hand Surgery, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Kuschner
authors.affiliation: Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Carey
authors.affiliation: Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address: aghiassi@usc.edu.
authors.forename: Alidad
authors.initials: A
authors.lastname: Ghiassi
mesh_terms: D002102:Cadaver; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D008297:Male; D009339:Needles; D019637:Orthopedic Procedures / Q000379:methods*; D010477:Perfusion; D059348:Peripheral Nerve Injuries / Q000517:prevention & control; D013708:Tendon Injuries / Q000517:prevention & control; D013710:Tendons / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery*; D052582:Trigger Finger Disorder / Q000601:surgery*; D017535:Ulnar Artery / Q000293:injuries; D018084:Ultrasonography, Interventional; D057772:Vascular System Injuries / Q000517:prevention & control
keywords: A1 pulley release; Percutaneous; perfused cadaver; trigger finger; ultrasound guidance