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

Abstract

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.

The fascia of the limbs and back – a review

“…The palmar fascia (synonym palmar aponeurosis ) is triangular‐shaped and located in the hollow of the palm. Its apex lies proximally near the wrist and is continuous with the flexor retinaculum and the tendon of palmaris longus, and its base lies distally near the fingers and sends four prolongations (pretendinous bands) into the fingers to blend with the fibrous flexor sheaths surrounding the flexor tendons (Fifield, 1939; de‐Ary‐Pires et al. 2007).…”

“…Branches of the bands give rise to cutaneous ligaments, eponymously referred to as Cleland's and Grayson's ligaments. These are thought to stabilize the neurovascular bundles within the digits during finger movements and to anchor the skin in a way that limits its displacement during finger flexion (de‐Ary‐Pires et al. 2007).…”

“…Non‐surgical attempts at correction are usually unsuccessful, though local injections of collagenase in the region of the cords are reported to be beneficial (Badalamente et al. 2002; de‐Ary‐Pires et al. 2007).…”

“…It is commonly bilateral and characteristically affects men over the age of 50 years, impinging significantly on daily work and home life (Townley et al. 2006; de‐Ary‐Pires et al. 2007).…”

Postoperative Voluminal Flap Reduction After Fingertip Reconstruction Using the Reverse Digital Artery Island Flap

“…Harvested flap was turned 180 at the pivot point, which was located at the mid-middle phalangeal level, so that the flap will reach the fingertip defect. To prevent flap congestion, six flaps were harvested together with a thin skin pedicle (case [11][12][13][14][15][16], and the other flaps had no skin pedicle. In many cases, skin grafts were applied to cover the tissue defect after harvesting the flap from the hypothenar (cases 2, 3), arch of a foot (5, 7), cubital fossa (8,9,11) and forearm (10,(12)(13)(14)(15)(16).…”