Volar Approach to Flexor Tendons

Bruner zigzag incision marked on the palmar surface of the finger for a volar approach to the joint
Bruner zigzag incision marked on the palmar surface of the finger for a volar approach to the joint. Image from Sawant RV, Darawade N, Sonawane D, Tawde A, Bhandari N. Reconstruction of Delayed Proximal Interphalangeal Joint Fracture-Dislocation Using Hemi-Hamate Arthroplasty, A Case Report. Cureus. 2024, 16(1), e52797. CC BY 4.0.
Gray’s Anatomy illustration of the flexor tendon sheaths
Synovial sheaths of the flexor tendons at the front of the wrist and fingers. Image by Henry Vandyke Carter, Gray’s Anatomy (1918), Wikimedia Commons, public domain.

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

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.