Synovial Fistula as a Complication of Release of A1 Pulley for Trigger Finger

Flexor Tenosynovial Fistula as a Complication after Endoscopic Trigger Finger Release: A Case Report

OBJECTIVE

We report a rare case of flexor tenosynovial fistula secondary to endoscopic release of the A1 pulley for treatment of trigger finger.

CASE PRESENTATION

A 72-year-old woman underwent endoscopic release of the A1 pulleys of her left ring and right middle fingers. Nine days after surgery, the wound at the base of the proximal phalanx of the ring finger (distal portal) remained open and a clear liquid discharge was seen. The volume of discharge increased with active finger motion. However, there was no evidence of infection. The patient was diagnosed with tenosynovial fistula as a complication of endoscopic release of the A1 pulley. At day 30, the fistula and drainage persisted and the condition was managed by surgical excision of the fistula and primary closure. The wound then healed completely.

CONCLUSION

Our report alerts hand surgeons to the potential development of flexor tenosynovial fistula as a very rare complication following endoscopic release of the A1 pulley for the treatment of trigger finger.

The Use of a Lumbrical Muscle Flap for Treatment of Chronic Tenocutaneous Fistula

Tenocutaneous fistulas after trauma or open release of the A1 pulley provide a unique reconstructive challenge. We describe the use of a lumbrical muscle turnover flap as a novel technique for managing these wounds and present its successful use in a patient with a tenocutaneous fistula after A1 pulley release of the middle finger. This flap provides a simple, local reconstructive option in patients with an array of palmar wounds that have failed conservative management.