All affected rays of a hand were treated during a single session. Portal sites in areas of definite cords were carefully chosen and marked with a surgical marker. Portals were spaced 5 mm apart and were not made in skin creases. After marking the portals, 0.1 mL or less of a lidocaine 1 % w/v solution and epinephrine (1:100,000) were injected into each site to be treated. Working in a distal-to-proximal direction, a 25-gauge needle was used as a scalpel to release the cord at multiple levels. As previously described by Eaton (2011), three basic moves—clear, perforate, and sweep—were performed to transect diseased cords. The needle was changed frequently to maintain sharpness. After division of the cord, the fingers of treated rays were passively extended to obtain maximal release. Portals and nodules were subsequently injected with a 10 mL lidocaine 1 % w/v solution and 20 mg triamcinolone acetate mixture because its efficacy had been proved by McMillan and Binhammer (2012) in their randomized controlled trial study, and it is also known that steroids downregulate cell proliferation and induce apoptosis by affecting collagen ratios and fibroblast activity at the molecular level (Meek et al. 1999, 2002).

Postoperatively, a light gauze bandage dressing was applied and removed the next day if the skin had not ruptured. Immediately after the procedure, a fiberglass volar or ulnar gutter splint was applied to mold night splint, and its use at night was recommended for up to 3 months. No restrictions were applied to daily activities. Patients were encouraged to start increasing the motion of their hand immediately after the procedure, although they did not receive formal hand therapy.