Complications - Division of the A1 pulley

• Lesion/Transection of digital nerve or artery
• Splitting of the A-2 pulley with creation of a bow-string phenomenon
• Tendon injury
• Incomplete splitting of the pulley with persistent triggering phenomenon

Management

• Primary microsurgical nerve or artery suture in case of nerve or artery injury
• Tendon reconstruction
• Careful splitting of the pulley with determination of its boundaries

Acute Complications

• Bleeding/Hematoma
• Infection/Wound healing disorder/pyogenic synovitis/Synovial fistula

Management

• Possibly evacuation of the hematoma
• In case of infection and pyogenic synovitis, immediate surgical revision
• In case of wound healing disorder and synovial fistula, surgical revision depending on the severity of the condition

Late Complications

• Recurrence
• Prolonged scar pain
• Movement restriction due to tendon adhesion and/or joint contracture
• CRPS (Sudeck's disease)

Management

• In case of recurrence, repeat annular ligament release
• In case of movement restriction or scar complaints, hand therapy measures (physiotherapy, splinting, desensitization)
• Indication for tenolysis or arthrolysis should be considered cautiously, as the results are often unsatisfactory
• For CRPS, appropriate treatment of the condition (see medical literature)