Percutaneous Trigger Finger Release : Donald Ditmars MD, FACS

Donald M Ditmars, Jr., M.D., FACS

Currently a staff plastic surgeon in the Division of Plastic Surgery in the Department of Surgery in the Henry Ford Health System. He joined the plastic surgery staff in 1970 and became the Division Head of Plastic Surgery from 1981 until 2007. Hand surgery has been and still is a major component of his practice. His major contribution to the practice of hand surgery over the years has been the utilization of local anesthesia for almost all procedures including trigger finger releases. Residents and medical student education has always been a major interest; he has produced several decades of teaching photographs, slides, presentations, movies and videos.

In the early 1970s, all trigger finger releases were done using the open technique which involved direct visualization of the proximal flexor tendon sheath which was divided under direct visualization. This involves sutures and healing of the skin wound which required several weeks to heal for relatively normal function. On a few occasions at that time, a residual band of the flexor tendon sheath would remain causing a persistent triggering. The first use of the percutaneous needle technique involved the limited release of these bands without incurring another operation. This concept was so effective that it was soon adapted to primary trigger fingers. There was general reluctance by the hand surgeons of the time to adapt this technique because of a concern for injury to the flexor tendon which is immediately deep to the flexor tendon sheath. The initial technique indeed used a sweeping motion of the needle which could cause longitudinal lacerations of the tendon. Over the years, even though there was very little clinical evidence of damage to the tendons, the technique was modified so that there is now all almost no chance for damage to the underlying tendon. Also finding the flexor tendon sheath in the first place was made much easier with the local anesthesia injection being done first by the surgeon.

Although there are now several surgeons doing the procedure, the current technique for the percutaneous release of trigger fingers demonstrated in the video is much less prone to tendon injury injury than others that are being shown. It is still in operation however with a much smoother recovery with fewer limitations after surgery.

TRIGGER VIDEOS DISCLAIMER

Originally, this presentation was conceived as an instructional video for hand surgeons. It was later expanded in scope to include pertinent information for patient education. It has been very successful in informing patients about the procedure from the beginning to the end of the recovery period. The technical part, however, should be performed by hand surgeons who have intimate, precise knowledge of the anatomy, surgery and diseases involving the hand.