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Evaluation of Percutaneous First Annular Pulley Release: Efficacy and Complications in a Perfused Cadaveric Study
Don Hoang, MD1, Ann C. Lin, BS1, Anthony Essilfie, MD2, Alidad Ghiassi, MD2, Stuart Kuschner, MD3, Joseph Carey, MD1.
1USC Plastic and Reconstructive Surgery, Los Angeles, CA, USA, 2USC Orthopedic Surgery, Los Angeles, CA, USA, 3Hand Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Purpose: Despite percutaneous trigger finger release (PTFR) success rates over 94%, controversy remains over fear of neurovascular injury. We assessed the safety of blind versus sonographically-guided (US) first annular (A1) pulley releases performed on a perfused cadaveric model.
Methods: 124 finger/31 thumb percutaneous A1 pulley releases were performed on perfused un-embalmed cadavers (65 female, 90 male) and an 18-gauge needle. 45 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: 114 (74%) A1 finger and thumb pulleys were effectively released and only three 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. Use of US for PTFR was not more likely to result in a complete pulley release compared to Blind PTFR (80% versus 72%; P < 0.26).
Conclusion: 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. 
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