Table of Contents

 

A CHART OF PERNICIOUS OR INCORRECT INCISIONS IN THE HAND, ANY OF WHICH WILL DO HARM

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

(A) Median longitudinal incisions which cross flexion creases at right angles and result in flexion contractures. These are prevalent but pernicious.

(B) Median incision on dorsum of finger which later leaves a scar that contracts and hinders flexion of the finger. When present, it is impossible to fashion a proper skin flap under which to repair the extensor tendon.

(C) Anterolateral incision in finger which is directly over and endangers the vessels and nerve. It is the usual one pictured for draining tendon sheaths, but should instead be mid-lateral.

(D) Incision which thoughtlessly severs the motor thenar nerve and so robs the thumb of the power of opposition.

(E) Median longitudinal incision through matrix will produce a ridged nail.

(F) Incisions for paronychia often pictured, but erroneous, as they do not drain the bottoms of the clefts formed by the borders of the base of the nail which curve strongly forward.

(G) Median longitudinal incision in pulp for draining of a felon. It will not drain, as due to cleavage planes the pus progresses in spite of it and points dorsilaterally. Also, the scar resulting is in the tactile surface.

(H) Alligator-mouth incision wrongly placed too far anteriorly which leaves a scar in the tactile surface.

(I) Incision across a web injures the web which itself has a function of complicated foldings to allow for movement of thumb.

(J) Incision often made for drainage of pus in sheath of tendon to little finger. The tendons, however, converge sharply in palm to pass between the ridge of the trapezium and the unciform process of the unciform bone.

(K) Incision continuous from finger to palm severs nerve, thus rendering half of finger permantly anaesthetic.