Table of Contents

 

A CHART OF ADVISABLE OR CORRECT INCISIONS IN THE HAND WHICH WILL AFFORD ACCESS AND WILL NOT CAUSE DISABILITY

Sterling Bunnell, Surgery of the Hand, 2nd edition, J. B. Lippincott, 1948

(A) Incision opening palm or draining middla palmar space, parallels flexion creases, exposes by triangular flap, enters between median and ulnar nerve supplies, and may be extended through ulnar side of carpal ligament up forearm. Curve crossing creases in wrist avoids contracture.

(B) Drainage for thenar space, parallels thenar crease. Must not sever the thenar motor nerve. Pedicles between it and palmar incision must be wide enough to nourish intermediate skin.

(C) Usual drainage for thenar space. Should be radial to interosseus muscle and not sever radial artery in cleft.

(D) Mid-lateral incisions in digits, spare nerves and vessels and do not cause flexion contractures.

(E) Drainage for pulp abscess, posterior to tactile surface. Should severt the vertical fat columns and not cause tenosynovitis by nicking sheath of flexor tendon.

(F) Flap exposure to not overlie extensor tendon.

(G) Exposure of insertion of extensor tendon.

(H and I) Drainage of collar-button abscess. Avoid volar nerve.

(J) Flap drainage of subcutaneous abscess. One arm is median to nerve and the other blocks upward extension of infection.

(K) Transverse incisions parallel wrinkles, thus avoiding conspicuous keloid formation.

(L) Drainage for quadrilateral space in forearm. Made anterior to bone and radial nerve and posterior to dorsal branch of ular nerve.