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Wheeless' Textbook of Orthopaedics

Finger and Hand Incisions



- See:
    - Finger Tip Injuries

- Brunner Type Incisions:
    - The zig-zag volar-digital incision for flexor tendon surgery.

- Midaxial Incision:
    - indications: septic arthritis of IP joints and MP joint of thumb;
    - site for placing midaxial incision is performed by  flexing finger & marking the point at each joint where the flexion crease ends;
           - points are connected which identifies the midaxial line;
    - begin the incision on midlateral aspect of finger at level of proximal finger crease and carry it distally to PIP joint just dorsal to flexor skin crease;
    - since flexor since creases extend slightly over half way around finger nail, incision is made slightly posterolateral;
    - continue incision in central portion of each finger segment;
    - fat is more plentiful centrally than it is over joint, & allows greater safety margin;
    - since fat is scanty over PIP joint, and be careful not to enter it by mistake;
    - immediately after incising the fat, carry the dissection volarward deep to the nueorvascular bundle and expose the tendon sheath;
    - digital nerve and artery lie approximately 2 mm volar to the margin of incision, so it is best to preserve thickness of fat on volar flap;
          - note that the common digital nerve divides at the palmar aspect of the proximal phalanx;
    - develop the dorsal flap a little to aid in closure of the incision;
    - on radial sides of index and middle finger & ular side of little finger is a dorsal branch of the digital nerve that should be preserved when possible;
    - dissection of Cleland's ligament;
           - after skin incision, first structure encountered is Cleland's ligament;
           - this contains fibers that run in volar to dorsal direction & connect thiner fascial layers surrounding digital nerve and artery with skin;
           - Cleland's ligament can be isolated from adjacent fat at the level of PIP joint to allow it to be resutured during closure;
                 - resuturing of ligament may prevent hyperextension deformities at PIP jont;
           - once Cleland's ligament is divided,  further dissection will expose side of phalanx, & margin of the flexor sheath;
    joint inspection:
           - enter the joint between the volar plate and the accessory colateral ligament



Variations in digital nerve anatomy.

The digital palmar oblique incision.

A modified midlateral incision for volar approach to the digit.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, August 13, 2012 4:43 pm