Volar Approach to Flexor Tendons

Position

  • Supine
  • Arm board
  • Tourniquet

Landmarks

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

Incision

  • Brunner zig-zag volar digital incision
    • 90° to each other
    • angled at each skin crease
    • not too far dorsal as endangers neurovascular bundle

Internervous Plane

  • None
    • Area of 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