Flexor Digitorum Superficialis Excision

This is a technique to isolate and excise the ulnar slip of the flexor digitorum superficialis tendon without incising the A2 pulley. Partial FDS excision is helpful in patients who have palpable triggering beneath the A2 pulley and in those with chronic trigger finger associated with PIP flexion contracture. Excision of only the distal portion of the ulnar slip of the tendon may not provide adequate decompression for this purpose. The technical difficulty with complete excision is that the fibrous decussation lies within the A2 region, and the tendon proximal to this may be difficult to access. This technique uses a loop of 26 gauge wire to isolate the ulnar slip and deliver it distally so that the decussation may be retrieved and divided distally, facilitating complete excision.

Steps:
  • Pass wire loop around the ulnar slip through an A1 pulley exposure.
  • Pass a loop from the distal to the proximal pulley
  • Retrieve the proximal loop
  • Divide the Ulnar FDS proximally
  • Deliver the tendon slip to the distal incision
  • Divide the decussation
  • Disinsert the tendon slip
Animation of the steps:



Surgical video summary:


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