Optimum skin incisions for the surgical relief of stenosing tenosynovitis in the hand

Effectiveness of surgical interventions for treating de Quervain's disease: A systematic review and meta-analysis

Introduction

This systematic review of randomized controlled trials was undertaken to assess whether any of the various currently used surgical interventions have better functional outcomes and less impairment or fewer surgical complications compared to the other common surgical interventions in de Quervain's disease.

Material and methods

Relevant studies related to surgical interventions in de Quervain's disease based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were identified from PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing surgical interventions in de Quervain's disease published from January 2000 to December 2020. Functional outcome and impairment were the primary outcomes assessed.

Results

Three trials met the eligibility criteria which were following randomized controlled trial or quasi-experimental trial enrolling adults ≥18 years of age diagnosed with de Quervain's disease, comparing clinical outcomes between different surgical interventions, and including functional outcomes, impairment, pain and complications data. The Cochrane Risk of Bias Assessment Tool and GRADE approach were used to ascertain methodological quality. Statistical heterogeneity was tested with I-square and chi-square tests. The longitudinal skin incision probably slightly reduced superficial radial nerve injury, vein injury, scar hypertrophy, and total complications compared with the transverse skin incision with relative risk: 0.14, very low certainty by GRADE; 0.10, very low certainty by GRADE; 0.57, very low certainty by GRADE; and 0.23, very low certainty by GRADE, respectively.

Conclusion

Concerning the analysis of functional and pain scores, no significant results were able to be concluded. This study's findings must be considered in the light of quality and sample size limitations, and further high quality prospective randomized controlled clinical trials are needed to draw more firm conclusions.

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There has a various surgical treatment for radial styloid tenosynovitis. If the surgeon known the update evidence in each method will help them to deal with patient diagnosed radial styloid tenosynovitis.

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The current systematic and meta-analysis review depicted the evidence surgical options in terms of effectiveness and complications.

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This study's findings must be considered in the light of quality and sample size limitations, and further high quality prospective randomized controlled clinical trials are needed to draw more firm conclusions.

Optimal surgical approach for the treatment of Quervains disease: A surgical-anatomical study

AIM

To determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the nerves which at risk are the superficial branch of the radial nerve (SBRN) and the Lateral Antebrachial Cutaneous Nerve (LABCN).

METHODS

Twenty embalmed arms were dissected and the course of the SBRN and the LABCN in each individual arm was marked and the distance between the two branches of the SBRN at the location of the First Extensor Compartment (FEC) was measured. This data was used as input in a visualization tool called Computer Assisted Anatomy Mapping (CASAM) to map the course of the nerves in each individual arm.

RESULTS

This image visualizes that in 90% of the arms, one branch of the SBRN crosses the FEC and one branch runs volar to the compartment. The distance between the two branches was 7.8 mm at the beginning of the FEC and 10.2 mm at the end. Finally the angle of incision at which the chance of damage to the nerves is lowest, is 19.4 degrees volar to the radius.

CONCLUSION

CASAM shows the complexity of the course of the SBRN over the FEC. None of the four widely used incision techniques has a significantly lower chance of iatrogenic nerve damage. Surgical skills are paramount to prevent iatrogenic nerve damage.

Comparison of three different incision techniques in A1 pulley release on scar tissue formation and postoperative rehabilitation

INTRODUCTION

The optimal surgical approach for trigger finger release remains controversial in hindsight of postoperative rehabilitation as well as scar tissue formation. In this study, we comparatively evaluated the outcome of three different types of skin incision by employing the "Disability of the Arm Shoulder and Hand Score" (DASH) and by quantitative ultrasound measurements of scar tissue volume.

MATERIALS AND METHODS

Thirty patients (32 triggerfingers) were enrolled in this study and randomly assigned to one of three groups: incision placed (1) transversal in distal palmar crease, (2) transversal and 2 mm distal from distal palmar crease, (3) longitudinally over MCP joint without crossing the distal palmar crease. Patients characteristics were noted and DASH scores were retrieved at four time points, (1) preoperatively (baseline), (2) 1 month, (3) 3 months, (4) 12 months postoperatively. Scar volume formation was assessed by ultrasound at 3 months postoperatively in 28 patients.

RESULTS

All groups showed a significant reduction in DASH values at 3 and 12 months postoperatively when compared to their own baseline levels. Group 3 showed the fastest and most pronounced reduction in DASH values at 1 month. Scar tissue formation was almost 57 % increased in group 1 vs group 2 and 3, however, not significant.

CONCLUSION

There is no clear benefit of one incision technique over another. However, based on scar volume parameters, the significant faster recovery in the first month and the surgical ease of exposure and wound closure inclines us to favor the longitudinal incision (group 3) in future patients.

Two-Step Incision for Periarterial Sympathectomy of the Hand

Background

Surgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire.

Methods

A total of 40 patients (17 men and 23 women) with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS) and the Wake Forest University rating scale.

Results

The total patient score was 8.59 (range, 6-15) in the two-step incision group and 9.62 (range, 7-18) in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034) but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03).

Conclusions

Compared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.

De quervain disease: Ibri technique to avoid superficial radial nerve injury

Tenosynovitis of the first dorsal compartment of the wrist, commonly known as de Quervain disease, is most of the time amenable to conservative treatment in form of splinting and injection of steroids into the compartment. Resistant cases need surgical release of the compartment but with high incidence of incomplete release owing to tendon anomalies and damage to the superficial branch of the radial nerve (SBRN). Many techniques evolved for a period of years, techniques using longitudinal, transverse, and oblique incisions, but damage to SBRN still remains unsolved. The authors describe a technique they have been using since 2004 and, so far, operated on 17 wrists without a single incidence of damage to the SBRN.

Variations in incisions and postoperative management in carpal tunnel surgery

This study examines the variations in incisions and postoperative protocol of open carpal tunnel release. A questionnaire was distributed to 65 hand surgeons. Respondents were asked to draw their preferred incision on original photocopies of the same palm. The results were measured against standard anatomical landmarks (thenar crease, vertical axis of the third web space, proximal palmar crease and the distal wrist crease). The participants were also asked to answer questions concerning their postoperative protocols. Demographics of the cohort, as well as the variations in incisions and postoperative management, were analyzed. Significant variations existed in the length and location of the incision in the palm. The differences in postoperative care in this cohort of surgeons were less significant.

The first dorsal extensor compartment: an anatomic study

Sixty-six cadaver hands were dissected to better define the anatomic variations of the first dorsal compartment and the superficial radial nerve. A septum was present in 31. A separate compartment enclosed the extensor pollicis brevis tendon in 29 and a slip of the abductor pollicis longus in 2. Multiple slips of the abductor pollicis longus tendon were noted in 38. Accessory slips inserted into the trapezium and thenar musculature. Partial separation or grooving of the abductor pollicis longus tendon was common but did not necessarily define a separate tendon slip.

de Quervain's release in working women: a report of failures, complications, and associated diagnoses

Examination of a series of 16 consecutively referred women patients who have had a de Quervain's release revealed 23 associated diagnoses and 14 complications. Also, 11 consecutive women patients were referred preoperatively and, even in this small group, there were eight associated diagnoses. The complexities of de Quervain's tendinitis and the diagnosis and treatment of associated diseases and complications are described to help prevent surgical failures and prolonged disabilities in these groups of working women.

Preservation of terminal branches of the median palmar cutaneous nerve in carpal tunnel surgery

Surgical decompression of the median nerve in the palm and wrist usually relieves the symptoms of carpal tunnel syndrome. However, a significant number of these patients develop postoperative dysesthesia and local tenderness at the base of the palm. We have altered our surgical approach to include exposure and preservation of the terminal branches of the palmar cutaneous nerve in order to minimize the risk of this complication.