Volar Approach to Flexor Tendons of the Hand

Position

Supine
Arm board
Torniquet

Landmarks

Skin creases
- Distal Interphalangeal crease
  - Just proximal to DIPJ
- Proximal interphalangeal crease
  - Just proximal to PIPJ
- Palmer digital crease
  - Well distal to MPJ

Incision

Make zigzag incision
- 90° to each other
- angled at each skin crease
- not to far dorsal as endangers neurovascular bundle
A Z plasty
B Zig zag
C Zig zag
D Volar flap incision
E volar side of thumb & thenar area
F trigger finger & proximal tendon sheath
G flap over hypothenar area
H middle of palm
J trigger thumb

Internervous Plane

NONE
- Area is skin is supplied by nerves on either side of incision

Superficial Dissection

Reflect skin flaps with underlying fat
- Starting at apex
- Using skin hook & scissors

Dangers

Digital nerves & vessels
- Especially if skin incision extends too dorsal
Necrosis of skin flaps
- Especially if cut at an acute angle
- Skin flaps should be thick
Avoid 90° angles across skin creases, leads to contractures