Trigger Finger Pathway Updated: 10/4/2016

Trigger Finger Release

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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Execute surgical walkthrough

  • describe the steps of the procedure verbally prior to the start of the case

2

Description of potential complications and steps to avoid them

F

Room Preparation

1

Surgical Instrumentation

  • Loupe magnification

2

Room setup and Equipment

  • standard operating table
  • hand table

3

Patient Positioning

  • patient placed in the supine position with hand on hand table
  • place tourniquet high on the affected extremity
G

Superficial Dissection

1

Mark and make incision

  • mark and make a 1 cm incision directly over the affected A1 pulley
  • avoid crossing palmar skin creases at a right angle with any incision type
  • incise only the skin and dermis with a no. 15 blade
H

Deep Dissection

1

Dissect through subcutaneous tissue

  • use blunt dissection to spread the subcutaneous tissue
I

Neurovascular Structure Identification

1

Identify the neurovascular structures

  • protect and retract the neurovascular structures
  • the digital radial nerve is the nerve that is most at risk because it typically crosses the surgical field
J

A1 Pulley Release

1

Expose the A1 pulley

  • use a sponge to expose the A1 pulley

2

Release the A1 pulley

  • do not incise the A1 pulley until it is completely exposed
  • use a knife to start the A1 pulley incision
  • complete the release with scissors until the leaflets of the A1 pulley can be completely spread apart
  • avoid cutting the A2 pulley
K

Wound Closure

1

Irrigation and hemostasis

  • copiously irrigate the wound

2

Superficial closure

  • use 4-0 nylon to close the skin

3

Dressing and immediate immobilization

  • place in soft dressing
Postoperative Patient Care
 

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