Anatomic variations in sensory innervation of the hand and digits

Bas, Heidi; Kleinert, James M.

doi:10.1053/jhsu.1999.1171

Cited by 129 publications

(103 citation statements)

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“…In those cases of finger reconstruction, the digital nerve (Bas and Kleinert, 1999) is included in the pedicle (Giunta, 2003). When performing a cross-finger flap, the skin of the donor finger is mobilized out of the extensor surface until Cleland's ligament is reached.…”

Section: Discussionmentioning

confidence: 99%

Cleland's and Grayson's ligaments of the hand: A morphometrical investigation

et al. 2006

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The cutaneous ligaments of the human digits are delicate functional structures essential for normal skin stability during digital movements. These ligaments extend bilaterally between the phalanx and the finger dermis, either posteriorly (Cleland's ligaments) or anteriorly (Grayson's ligaments) to the digital neurovascular bundles. We have performed a series of detailed anatomical dissections of the human digits so as to investigate morphometrically Cleland's and Grayson's ligaments and their topographic arrangements. Data were statistically compared between fingers, respecting both side (left or right) and sex, in an attempt to clarify some of the morphologic variations of these structures. The cutaneous ligaments of the human digits have been analyzed bilaterally both in 30 fixed cadavers (300 adult human digits) and in 10 nonfixed human cadaveric digits. A computerized morphometrical investigation of the human digits and their Cleland's and Grayson's ligaments has been performed and the resulting quantitative data have been statistically assessed, comparing groups according to finger, phalanx, side (left or right hands), and sex. The ratio between the origin and insertion (O:I) of these ligaments indicate a divergent arrangement of fibers, with values varying from 0.52 to 0.84, depending on the phalanx and finger analyzed. Our morphometrical data provide normal reference values, mainly for Grayson's ligaments, that can be useful in the comparison with the respective measurements obtained in Dupuytren's disease. Morphological bases are also provided, which may be relevant either in computerized tomography or magnetic resonance imaging involving the hand region and in their application in surgical procedures of the human hand.

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Section: Discussionmentioning

confidence: 99%

Cleland's and Grayson's ligaments of the hand: A morphometrical investigation

et al. 2006

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“…As reported elsewhere, inclusion of the dorsal nerves (corresponding chiefly to the dorsal aspect of the first phalanx) was not reliable (7). It should be kept in mind that the innervation pattern of the dorsal aspect of the fingers is highly variable, as reported by Bas and Kleinert (9). The sensory supply to the dorsum of the distal phalanxes and nail beds can arise from both the proper digital nerves and the dorsal sensory nerves (the terminal branches of radial or ulnar sensory nerves).…”

Section: Discussionmentioning

confidence: 92%

Reducing patient discomfort during digital blockade: The subcutaneous single injection digital block - A simple, safe and fast procedure

Brutus¹

2003

J Plast Surg

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BACKGROUND: Regional anesthesia of a single finger is commonly achieved by the traditional ring block, which requires at least two painful injections in the digit. Single injection digital block techniques have been described to avoid this problem. Among these, the subcutaneous technique described by Harbison appears to be safe and to allow most procedures to be carried out with good tolerance. OBJECTIVES: A prospective study was designed to evaluate the results of the subcutaneous technique in terms of patient tolerance, distribution of anesthesia and efficiency. METHODS: All blocks were performed by a single investigator. A visual analog scale was used to evaluate pain associated with the injection. Prick testing was used to evaluate the quality of anesthesia at the volar and dorsal aspects of the phalanxes. Tolerance to the surgical procedure and the need for additional injections were also recorded. RESULTS:This technique allowed surgery to be performed without complementary injection most of the time and was very well tolerated. The dorsum of the proximal phalanx, however, was unpredictably included in the anesthetized territory. CONCLUSION: The subcutaneous single injection digital block is safe, efficient and easy to perform. It allows the treatment of all conditions on the volar aspect of the finger and on the dorsal aspect of the distal and middle phalanxes. For surgery on the dorsal aspect of the proximal phalanx, a combined single injection technique or a supplementary dorsal block should be used.

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“…14 In 1999, Heidi Bas and James M Kleinert observed the communicating branches between the median and ulnar nerves in 20 palms (67%) out of 30 specimens used for study. 15 These interconnections are at risk when releasing the distal aspect of the TCL during open or endoscopic carpal tunnel release. Aggressive retraction in this region and placement of the endoscope further distal to the TCL should both be avoided in order to prevent traction injury to these nerves resulting in paraesthesia in the long or ring finger distribution.…”

Section: Discussionmentioning

confidence: 99%