Complications - Division of the A1 pulley

• Lesion/Severance of digital nerve or artery
• Concomitant division of the A-2 pulley with creation of a bow-string phenomenon
• Tendon injury
• Incomplete division of the pulley with persistent snapping phenomenon

Management

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

Acute Complications

• Bleeding/Hematoma
• Infection/Wound Healing Disorder/Pyogenic Synovitis/Synovial Fistula

Management

• If necessary, 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 findings

Late Complications

• Recurrence
• Prolonged Scar Pain
• Restriction of Movement due to Tendon Adhesion or/and Joint Contracture
• CRPS (Sudeck's Disease)

Management

• In case of recurrence, repeated pulley release
• In case of restriction of movement or scar complaints, hand therapeutic measures (physiotherapy, splint supply, desensitization)
• Indication for teno- or arthrolysis should be made cautiously, as the results are often not satisfactory  
• In case of CRPS, appropriate therapy of the disease (see specialist literature)