Division of the A1 pulley

Preliminary note

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

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

Guiding structures:

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

Expose the flexor tendon sheath over a length of 2 cm by blunt dissection of the subcutaneous tissue using dissecting scissors.

Caution:

Radial and ulnar vascular/nerve bundles!