Midlateral approach to flexor sheaths

Position

• Supine
• Arm board

Landmarks

• Proximal interphalangeal crease
• Distal interphalangeal crease
• Junction between volar smooth skin & dorsal wrinkled skin
  • (which is more dorsal)

Incision

• Direct dorsolateral longitudinal incision
• Stay on the more dorsal side (junction of smooth & wrinkled skin)

Internervous Plane

• None

Superficial Dissection

• Incise subcutaneous fat in line with skin incision
• Dangers
  • Neurovascular bundle is in the volar flap
    • Volar branch of digital nerve & artery
  • Dorsal branch of digital nerve

Deep Dissection

• To get to tendons
  • Incise fibrous flexor sheath longitudinally

Dangers

• Palmer digital nerve
• Volar digital artery