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It's Just Another Trigger Finger
Frank Yuan, MD
Maleeh Effendi, MD
Peter Stern, MD
University of Cincinnati
2021-01-30
Presenter: Frank Yuan, MD
Affidavit:
The abstract submitted within contains completely original work of the residents who are listed on this abstract.
Director Name: Ann Schwentker
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction: Open A1 pulley release for trigger digits has generally been considered a minor procedure with infrequent complications. However, some studies have reported complication rates up to 43%. Most reported complications are minor, including scar pain and tenderness, mild extension lag, and recurrence of triggering. Rates of major complications, such as bowstringing, neurovascular bundle injury, and infection requiring reoperation, are less than 1-4%. We aimed to describe the potentially devastating sequelae of postoperative wound infection, and the subsequent consequences.
Methods: Three patients underwent trigger finger release complicated by severe postoperative infection requiring multiple subsequent procedures. All 3 patients had a permanent functional deficit. We review our initial management, subsequent reconstructive options, and outcomes.
Results: All three adult patients underwent open A1 pulley release for trigger finger, and subsequently developed a surgical site infection, leading to flexor tenosynovitis requiring urgent operative debridement, followed by multiple additional procedures. Two patients were poorly controlled diabetics, and the third patient (an orthopaedic surgeon) was otherwise healthy. Each patient ultimately developed distinct consequences from their postoperative course – finger stiffness and contracture, disabling bowstringing requiring the use of a pulley ring, and flexor tendon rupture requiring staged tendon reconstruction, respectively. All three patients at final follow-up had a permanent functional deficit.
Conclusion: Major complications after trigger finger release are infrequent. However, if left untreated, particularly in diabetic patients, can lead to disastrous consequences, such as permanent loss of function. Our series of case reports highlights the importance of accurate diagnosis of postoperative infections and expedient treatment thereafter.
