Ultrasound-guidedtriggerfingerrelease:asafersurgicalprocedure(50cases)?HYPOTHESISUltrasound-assistedpercutaneoustriggerfingerrelease,withneedles,hasshownsomeincompletereleasesandmorbiditiesontendonsandbundles.1,2,3,4buthasalsoshownsomebenefitsinrecovery.Ourobjectivesweretodevelopasaferprocedureforpercutaneoustriggerfingerrelease,usingspecificultrasoundguidanceandadedicatedblade;thenanalyzetheoutcomesofthissurgicaltechniqueinaclinicalcontinuousseries.METHODSCadavericlab:6specimenswereoperatedonbothsides,oneachfingersexceptthumbs(48fingers).Weusedaspecificblade(1,8mmthin,nondisposable,blunttip)andaLogiceGEultrasounddevicewithahighfrequencytransducer(theL10-22-RS).Weperformeda1,5mmincisionintheMPskinfoldenablingaretrogradesectionoftheA1pulleyduringanIn-Planeapproach.Then,ineverycase,weevaluatedthetendonsandtheneurovascularbundleswithanopentechnique.Prospectiveclinicalseries:Underlocalanesthesia,50consecutivepatientswereincluded,24gradeIII-IV,18failuresofsteroidinjectioningradeI-II,8gradeI-IIdiabeticpatientswithoutpreviousinjection;3forefingers,27thirds,17middles,3littles.Ultrasound-guidedsteroidinjectionwasdoneattheendoftheprocedureineachcase.Adressingwaskeptforonedayandaclinicalexaminationwasperformedafter1and3months.ClinicalexaminationswithVASwereperformedpre-operativelyandpost-operatively.

RESULTSI-Cadavericlab(n=48):noneimpairmentofbundles,2superficialtendonslacerations,incompletesectionofA1pulleywasobservedinonly2fingers(little).II-Clinicalseries(n=50):Peroperative:durationofsurgerywas10minutes(5-18),triggerreleasewasobtainedimmediatelyinallgradeIII&IVPostoperativeoutcomes:norecurrenceoftriggerfingerwasnoticed,nonesensitivedisorders.Thesatisfactionratewas96%.4patientswerestillpainfulafter3monthsbutimprovedinallfourcases:onewasagradeIV,threeagradeI;twolittles,onethirdandoneforefinger.SUMMARYPOINTSInordertoimproveourresults,weconcentratedourworkon:

-adedicatedblade-aretrogradesection,sothatwestrictlyavoided

impairmentoftheA2pulley-anIn-Planeultrasoundapproachtogetacontinuous and

direct visualization oftheA1pulleysection-asteroidinjectionattheendoftheprocedureto

improvepainreliefandefficiency,forboostingrecovery.Ultrasound-guidedtriggerfingerrelease,withthis

procedure,isreliableandefficientontriggerrelease,withoutspecificmorbidity.LEVELOFEVIDENCE:IVPhotos

Photo1:Specificbladefortriggerfingerrelease:ablunttiptopenetrateintrasheathbeforethecuttingedge

Photo2:installationoftheultrasounddeviceandpositionofthesurgeonREMARQUES:1-Plaiecutanée:Danslatechniquepercutàl’aiguille,3passaged’aiguille18gaugesontraportécommeetantnecessaires,horsune18gaugefaitunmmcequifaituntotalde3mmd’ouverture,cequiestplusgrandqu’aveclalame.72-Dupuytrenetalgodystrophie:l’utilisationd’unetechniquemini-invasivecombinéeàuneinjectiondecorticoidlimitelerisqued’hyper-inflammationcicatricielleetvaparticiper,àmonavis,àunediminutiondesdouleurspost-op,desproblèmesdeDupuytrenréactionnel,desproblèmesd’inflammationetdouleurchroniqueetaussid’algodystrophie.Jepensequ’onesttouslesdeuxd’accordlàdessus.Malheureusement,cetravailnepermetpasdeleprouver,donc,jeprefereraienparleràl’oraldansladiscussion.LesAmerlocsontsurtoutcasse-couillesurlamethodo3-Plusbesoindegarrotdoncinteressantdanslesrarescontre-indicationsaugarrotBIBLIOGRAPHY

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