Congenital Deformities of the Hand and Upper Limb by Wei Wang & Jianmin Yao

Author:Wei Wang & Jianmin Yao
Language: eng
Format: epub
Publisher: Springer Singapore, Singapore

6.5.5.2 Surgical Treatment

As for the patients at the age of over 2 with disorder in finger flexion and extension, active surgical treatment should be given. The surgery can be performed during the infancy to prevent the occurrence of aplasia of the affected finger. The surgery should be performed under the condition of general anesthesia. The drape is disinfected according to the routine procedures, tourniquets are applied, and a transverse incision about 1 cm is made at the volar fold of the thumb metacarpophalangeal joint. The bilateral digital nerves should be protected. The thumb long flexor tendon and the tendon sheath are exposed, the tendon sheath becomes thickened, the tendons are continuously present but become thin, and there is adhesion of fibrous connective tissues around. Look for the proximal margin of the first trochlea, point the sticker cutting edge toward the distal end under the direct vision, perpendicularly cut the tendon sheath from the proximal end to the distal end, separate some of the tendon sheaths that become adherent to the fibrous connective tissues, and then move the affected finger; the free flexion and extension and the disappearance of the bouncing sensation indicate that the stenotic tendon sheaths have been longitudinally incised, and the inflated tendons can pass them freely. After the surgery, the entire layer of the incisions is sutured, and sterile dressings are used for ligation and fixation (Fig. 6.50). The main surgical point is to thoroughly release the stenotic sites of the thumb tendon sheath to avoid injuring the vascular nerves. After operation, it is necessary to strengthen the training of flexion and extension functions of the affected finger to avoid the recurrence of the adhesion.

Fig. 6.50Surgical treatment of congenital trigger finger. (a) Before the operation, the deformity of the trigger thumb is displayed, and Notta nodules are palpable at the proximal side of the A1 trochlea. (b) The thumb long flexor tendon and tendon sheath are exposed during the operation. (c) The annuliform trochlea is released and the thumb extending motions are recovered

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