Division of the A1 pulley

Preliminary Note

The procedure is demonstrated on the middle and ring fingers of the same hand. For didactic reasons, the individual steps are shown sometimes on one finger and sometimes on the other.

Anatomical orientation by palpation and marking of anatomical landmarks. Skin incision along the distal palmar crease directly over the A-1 pulley to be split. Sharp transection of the subcutis under bipolar coagulation of individual veins.

Guiding Structures:

• Distal palmar crease
• Flexor tendons
• Digital vessel/nerve bundle

Freeing the flexor tendon sheath over a length of 2 cm by blunt dissection of the subcutis using dissecting scissors.

Caution:

Radial and ulnar vessel/nerve bundle!