NEW MINIMALLY INVASIVE TECHNIQUE OF TREATING PATIENTS WITH "TRIGGER" FINGER
Stenosing ligamentitis of fingers (Nott’s disease, “trigger” finger) is one of the most common diseases in the ambulance practice of hand surgeons (up to 15% of all ambulance surgeries). This disease leads to significant deterioration of the palm function and grip strength, impaired quality of life, and even temporary disability in some activities. The goal of this work was to improve the results and to shorten the terms of treatment of trigger finger patients through development and clinical implementation of a new minimally invasive technique. We have developed and implemented the new minimally invasive technique for treatment of the Nott’s disease. It consists essentially in subdermal dissection of A1 pulley of injured finger with specialized needles 0.6-1.2 mm in diameter under local infiltration anaesthesia. Material and methods. The work consists of two parts: anatomic and clinical. The anatomic part was accomplished at 16 upper extremities of 8 unfixed dead bodies (80 fingers), peculiarities of structure of A1 pulleys of fingers were studied, approaches to them for minimally invasive dissection were proposed. In the clinical part of the work, the results of treatment of 184 patients with trigger finger aged from 28 to 80 years were analyzed. All 184 patients received minimally invasive ligamentotomy (215 surgeries). Results. The results of treatment were assessed by qDASH scale. The obtained results were excellent in 70% of cases, good in 20.3%, satisfactory in 7.5%, and unsatisfactory in 2.2%. The patients were observed for a term from 3 months to 7 years. Recurrent disease took place in 4 (2.2%) patients. The procedure took several hours and did not require hospitalization. The rehabilitation lasted 1-2 days. Вопросы реконструктивной и пластической хирургии № 2 (61) июнь’2017 54 Жигало А.В., Силаев А.К., Почтенко В.В. и др. Conclusions. The data obtained are indicative of the sufficient efficiency of minimally invasive ligamentotomy. Other positive factors of the surgery are the low cost of treatment and the low risk of complications. The technique can be mostly used in ambulance practice of hand surgeons having experience in upfront surgery. The implementation of this technique to the clinical practice has allowed the term of rehabilitation to be shortened from 21 to 1-2 days.