Optimal Skin Incision for the Surgical Treatment of De Quervain Tenosynovitis: A Systematic Review and Meta-Analysis

TL;DR

This study compares transverse and longitudinal skin incisions for treating De Quervain tenosynovitis and finds no significant differences in complications or pain outcomes.

Contribution

The study provides a systematic review and meta-analysis comparing two incision types for a specific wrist condition.

Findings

No significant difference in complication rates between transverse and longitudinal incisions.

Both incision types led to similar postoperative pain outcomes.

Evidence is limited, and future high-quality trials are needed to confirm results.

Abstract

Background and Objectives: De Quervain tenosynovitis (DQT) is a stenosing overuse condition of the synovial sheath of the first extensor compartment of the wrist. Open surgical release of the first dorsal compartment remains a standard intervention for DQT when conservative treatments fail. This systematic review evaluated the comparative efficacy of transverse versus longitudinal skin incisions for open release of the first dorsal compartment in DQT. Materials and Methods: Four studies with 259 patients were included in the review. Data from 17 patients were unavailable due to loss to follow-up; therefore, 243 wrists (242 patients) were included in the quantitative analysis. The transverse incision group consisted of 114 cases, and the longitudinal incision group of 129 cases. The primary outcome of the review was the incision-related incidence of injuries to adjacent anatomical structures, including injuries to the superficial branch of the radial nerve (SBRN), tendon injuries, and vein injuries. Secondary outcomes included hypertrophic scar formation, wound infection, and postoperative changes in pain severity measured using a visual analog scale (VAS). Results: Although there was a lower rate of SBRN injury in the longitudinal group (5.4% vs. 7% in the transverse group), the difference did not meet statistical significance (OR = 2.17; 95% CI, 0.39–11.99; p = 0.37; I2 = 30%). Similarly, there was no significant difference in the risk of vein injury (RD = 0.06; 95% CI, −0.03 to 0.14; p = 0.21; I2 = 61%), hypertrophic scar formation (OR = 1.39; 95% CI, 0.32 to 6.04; p = 0.66; I2 = 35%), and wound infection (RD = 0.00; 95% CI, −0.03 to 0.03; p = 0.93; I2 = 0%). Although both approaches resulted in significant pain improvement, no statistically significant difference in postoperative pain was observed between incision types, as assessed by the VAS for pain (mean difference = 0.30; 95% CI, −0.70 to 1.30; p = 0.56; I2 = 43%). Conclusions: No significant differences were identified between incision techniques for DQT in terms of complication rates and postoperative pain outcomes. However, the available evidence is limited, and future high-quality trials are necessary to determine any clinically meaningful difference. Therefore, incision selection should be individualized based on surgeon preference, patient-specific anatomy, and procedural complexity. Despite the technique used, meticulous surgical technique is essential to prevent postoperative complications.

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