Percutaneous Needle Technique Research Articles

Percutaneous Surgery for Trigger Finger Treatment Using a Novel Surgical Device: An Experimental Study on Fresh Cadavers

Trigger finger, a stenosing tenosynovitis of the flexor tendon at the A1 pulley, can cause pain and impair daily activities. Despite common surgical interventions, postsurgical complications are frequent, prompting the search for less invasive techniques. An experimental study was conducted on fresh cadavers to compare three techniques: the first using a PulleyCut without ultrasound guidance, the second using a PulleyCut with ultrasound guidance, and the third using a percutaneous needle technique. The complete release of the A1 pulley, integrity of the A2 pulley, flexor tendons, and neurovascular bundles were assessed. The new device group and the ultrasound-guided group demonstrated 100% complete release of the A1 pulley, whereas the needle group achieved only 38% success. There were no A2 pulley injuries in any group. Flexor tendons were injured in 7% of cases in the new device group and 77% in the needle group. A neurovascular injury occurred in the needle group. Compared with the percutaneous needle technique, the new device proved safe and effective for A1 pulley release, minimizing damage to flexor tendons and neurovascular structures. Ultrasound did not provide significant advantages, suggesting that the new device can be confidently used without ultrasound assistance. The PulleyCut represents a promising percutaneous technique for trigger finger treatment, demonstrating superiority over the needle technique in terms of efficacy and safety. These results encourage future clinical investigations to validate its practical application. Therapeutic IIc.

Trinity Lift: A Unique Technique for Endoscopic Midface and Lower Periorbital Unit Lift.

A harmonious face is defined in terms of a balanced relationship among all facial tissues. This balance among skin, fat, muscle, and bone is lost with aging as progressive changes occur in their volume, shape, position, and consistency. Aging of the human face generally starts in the third decade of life, mainly in the midface and periorbital areas. Traditional face-lifting surgeries result in minimal improvements in the midface area. Various techniques have been developed using different dissection planes and vectors with different forms of incision, including endoscopic techniques. We attempted to combine endoscopic subperiosteal dissection techniques with the percutaneous needle technique, especially in young- to middle-aged patients. We aim to share technical details of our preferred suspension and fixation method for an endoscopic midface lift with the aid of a percutaneous needle and to present the outcomes of this particular technique in 75 patients. Significant rejuvenation of the nasojugal groove was achieved, and patient satisfaction was high. All cases exhibited satisfactory, symmetrical, and stable elevation of the midface. None of the patients required a second surgery. Trinity lift allowed for stronger, easier, and faster application of sutures during endoscopic facial surgery without any other mucosal or transcutaneous incisions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effectiveness and Complications of Percutaneous Needle Tenotomy with a Large Needle for Muscle Contractures: A Cadaver Study.

BackgroundTwenty-two percent of institutionalised elderly persons have muscle contractures. Contractures have important functional consequences, rendering hygiene and positioning in bed or in a chair difficult. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not very effective and surgery may be required. Surgery is carried out in the operating theatre, under local or general anaesthesia but is often not possible in fragile patients. Mini-invasive tenotomy could be a useful alternative as it can be carried out in ambulatory care, under local anaesthesia.ObjectiveTo evaluate the effectiveness of percutaneous needle tenotomy and the risks of damage to adjacent structures in cadavers.MethodThirty two doctors who had never practiced the technique (physical medicine and rehabilitation specialists, geriatricians and orthopaedic surgeons) carried out 401 tenotomies on the upper and lower limbs of 8 fresh cadavers. A 16G needle was used percutaneous following location of the tendons. After each tenotomy, a neuro-orthopaedic surgeon and an anatomist dissected the area in order to evaluate the success of the tenotomy and any adjacent lesions which had occurred.ResultsOf the 401 tenotomies, 72% were complete, 24.9% partial and 2.7% failed. Eight adjacent lesions occurred (2%): 4 (1%) in tendons or muscles, 3 (0.7%) in nerves and 1 (0.2%) in a vessel.ConclusionThis percutaneous needle technique effectively ruptured the desired tendons, with few injuries to adjacent structures. Although this study was carried out on cadavers, the results suggest it is safe to carry out on patients.

Needle oophoropexy: a new simple technique for ovarian transposition prior to pelvic irradiation

Irradiation of the pelvis in the treatment of cancers will result in ovarian failure unless the ovaries are shielded adequately. To protect the ovaries, an oophoropexy may be performed. Our aim was to evaluate the feasibility, morbidity, and efficacy of laparoscopic ovarian transposition using a simple percutaneous needle technique. Fifteen patients (ten with rectal cancer and five with Hodgkin's disease) underwent the new laparoscopic oophoropexy technique. Laparoscopic releasing of the ovary was performed by cutting the utero-ovarian ligament followed by placing the ovaries on the anterior abdominal wall. A percutaneous straight needle was introduced through a 2-mm skin incision at the site of fixation. Repositioning of the ovaries was done on an outpatient basis without the need for readmission to the operating theatre. The technique was effective, reliable, and simple with no morbidities. Repositioning was performed simply in the outpatient clinic. At follow-up, 11 patients had evidence of ovarian function. Percutaneous needle transposition of the ovaries is a simple, effective, reliable, and easy-to-perform technique. It has short learning curve and can be done by less experienced laparoscopic surgeons.

Percutaneous needle aponeurotomy: complications and results

Recently French rheumatologists have repopularized fasciotomy using a percutaneous needle technique. This blind approach has been claimed to be plagued by numerous complications. We reviewed the charts of 211 patients treated consecutively on 261 hands and 311 fingers to assess the rate of postoperative complications. The first 100 patients were evaluated with a mean follow up of 3.2 years to assess the rate of recurrences and extension of the disease. In the whole group the mean age was 65 years and delay between onset and treatment was 6 years. Division of the cords were performed only in the palm in 165 cases, in the palm and finger in 111 and purely in the finger in 35. Complications were scarce without infection or tendon injury but one digital nerve was found injured during a second procedure. Postoperative gain was prominent at metacarpophalangeal joint level (79% versus 65% at interphalangeal level). The reoperation rate was 24%. In the group assessed at 3.2 years follow up, the recurrence rate was 58% and disease ‘‘activity” 69%. Fifty nine hands need further surgery. The ideal indication for this simple and reliable technique is an elderly patient with a bowing cord and predominant MP contracture. Chirurgie de la main 2001;20:206–211 © 2001 Editions scientifiques et medicales Elsevier SAS. Copyrights S1297-3202(01)0035-X/FLA.

Percutaneous needle aponeurotomy. Complications and results

Recently French rheumatologists have repopularized fasciotomy using a percutaneous needle technique. This blind approach has been claimed to be plagued by numerous complications. We reviewed the charts of 211 patients treated consecutively on 261 hands and 311 fingers to assess the rate of postoperative complications. The first 100 patients were evaluated with a mean follow up of 3.2 years to assess the rate of recurrences and extension of the disease. In the whole group the mean age was 65 years and delay between onset and treatment was six years. Rupture of the cords were performed only in the palm in 165 cases, in the palm and finger in 111 and purely at digital level in 35. Complications were scarce without infection or tendon injury but one digital nerve was found injured during the second procedure. Postoperative gain was prominent at metacarpophalangeal joint level (79% versus 65% at interphalangeal level). Reoperation rate was 24%. In the group controlled at 3.2 years follow up, recurrence rate was 58% and disease "activity" 69%. Fifty nine hands need further surgery. The ideal indication for this simple and reliable technique is an elderly patient with a bowing cord and a predominant MP contracture.

Isolated fifth digit localization in Dupuytren's disease

Isolated fifth digit localisation in Dupuytren's disease has a bad reputation. A series of this injury is reported with a special attention on recurrences. This series is composed of 30 cases in 26 patients (four bilateral cases): the majority of patients were male and 53.5 y was the average age. Extension loss of MP and PIP joints were present in 25 cases, MP isolated extension loss in two cases and PIP in three cases. The treatment performed was a percutaneous needle technique in five cases, surgical fasciectomy in 24 cases using a zigzag palmodigital longitudinal fasciectomy approach in 18 cases, an open palm technique in six cases and one isolated laterodigital flap. Assessment of correction was based on Tubiana's classification. Average follow-up was 22 months. Postoperative course was uneventful except for one case of precarious vascularisation which leads to an amputation. For the digitopalmar localisations: 15 stage 0 or 1, 7 stage 2, 1 stage 3 and 1 stage 4. Improvement percentage was 0.60 in combined cases, 0.65 in cases with a MP loss and 0.46 in PIP loss. Five recurrences were noted. Literature on this topic is coherent with the fact that isolated involvement of the fifth digit carry a bad prognosis, mainly due to the high recurrence rate in our series as in other papers. In severe injuries, an imperfect result should be the aim to prevent vasculonervous complications.

High proportion of type I fibres in thigh muscle of young dancers.

A previous study showed that adult female dancers have a high percentage of type I fibres in vastus lateralis, similar to that of endurance-trained female runners or female cross-country skiers. It is not known if dancers already at an early age are characterized by a high percentage of type I fibres or develop a high percentage of type I fibres as a consequence of dance training. Furthermore, the muscle fibre composition of male dancers has not previously been studied. Therefore the aim of the study was to analyse skeletal muscle fibre characteristics in 10-year-old and 20-year-old dancers of both sexes. Age-matched boys and girls whose physical activity was average for their age groups served as controls. Muscle biopsies for histochemical analysis were obtained from vastus lateralis using the percutaneous needle technique. The major finding of the present study was that the vastus lateralis of young dancers of both sexes had a higher percentage of type I fibres than that of controls. Moreover, the higher type I percentage was seen not only in 20 year olds, but also in 10 year olds, who had begun their dance training at a professional level only a few weeks earlier. No significant difference in this respect was found between female and male dancers. In conclusion, the muscle fibre type composition in young dancers of both sexes differs from that of the average individual of the same age and is characterized by a high percentage of type I fibres.