Surgical Exposures of the Hand


The hand and wrist are neurovascularly complex structures capable of motion in multiple planes. As such, a thorough understanding of the anatomy of the hand and wrist is critical to prevent iatrogenic injury during surgical exposures. Surgical incisions must be carefully planned to prevent scar hypersensitivity and unwanted contractures. Incisions may be created within flexion creases or at oblique angles to minimize tension on the skin and allow better scar formation, which may in turn improve cosmesis. Because a patient's pattern of skin creases is as individual as a fingerprint, creativity and flexibility in designing hand incisions are necessary. However, adherence to the basic principles of surgical incision-making will yield better cosmetic and functional results than a rigid one-scar-fits-all approach. This article reviews surgical approaches to the metacarpals, metacarpophalangeal joints, and phalanges commonly used for fixation of fractures, arthroplasty, and reconstructive surgery.

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