Кисть english

The meaning of hand and fingers is enormous for life. Person can’t fulfill a lot of jobs without hand or fingers. So, operative surgery of hand is a very important unit in general medicine.

Look at your hand! You can see some lines.
1) Thenar line
2) transverse proximal line
3) transverse distal line
In operative surgery and topographical anatomy this lines are used for determination of arteries and nerves projection.

If you divide thenar line into three parts and draw a square, where a proximal third is one side of square, you’ll get Kanavel’s prohibited area – the brunsh of n.medianus to m. opponens pollicis is located here. Incisions in this area are forbidden, because m. opponens pollicis may lost its function.

Transverse proximal line is projection of arcus palmaris superficialis

Transverse distal line is projection of metacarpophalangeal joint
Proximal interdigital line is the middle of proximal phalanx
Medium and distal interdigital line is interphalangeal [digital] joint

Scin and its characteristics:
Epithelial tissue consist of more then 100 rows of cells
Pigmentation, sebaceous glands, hair are absent
There are a lot of sudoriferous [sudoriparous] glands

Characteristics of subcutaneous fat
Slow subcutaneous fat regeneration.
Lack of fascia superficialis.
Subcutaneous fat in the fold area is considerably less.
Subcutaneous fat has cellular structure.

Characteristics of cellular structure
Purulent process tends to spreading inside
Infiltration anesthesia is very difficult – block anesthesia is used

Palmar aponeurosis has triangular shape.
One of the illnesses of palmar aponeurosis is Dupuytren's contracture.
Dupuytren's contracture

Dupuytren's contracture (also known as "Morbus Dupuytren," "Dupuytren's disease," or "Palmar fibromatosis", and sometimes misspelled as Dupuytren's constricture) is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended (straightened). It is named after Baron Guillaume Dupuytren, the surgeon who described an operation to correct the affliction.
Dupuytren's contracture is caused by underlying contractures of the palmar fascia. The ring finger and little finger are the fingers most commonly affected. The middle finger may be affected in advanced cases, but the index finger and the thumb are nearly always spared. Dupuytren's contracture progresses slowly and is usually painless. In patients with this condition, the tissues under the skin on the palm of the hand thicken and shorten so that the tendons connected to the fingers cannot move freely. The palmar aponeurosis becomes hyperplastic and undergoes contracture.

It’s operative [surgical] technique for Dupuytren's contracture

Skin innervation
1 – ulnaris, 2 – medianus 3 - radialis
Lack of sensitivity in different parts of hand is a result of damage of nervs

Innervations of muscles
N. medianus – m.m. of thenar , 1,2 lumbrical muscles
N. ulnaris m.m. of hypothenar, 3,4 lumbrical muscles, all m.m. interossea
N. radialis – flexors on fore arm
Symptoms of nerves damage:
N. medianus – «Gynecologist’s hand»
N. ulnaris– «clawhand», and/or symptom «sheet of paper»
N. radialis– «chicken hand»

Blood supply

Tendons and ligaments of fingers
Every finger has m.flexor digitorum superficialis and m.flexor digitorum profundus
Tendons are surrounded with bursa synovialis
bursa synovialis begin from distal phalanx and ends:
Bursa of thumb ends on the fore arm
Bursa of 2, third, fourth fingers end on the metacarpophalangeal jonts
Bursa of fifth fingers takes tendo of m.flexor 4,3,2 fingers and ends on the fore arm
Also, There is a mesenterium near the basis of tendo m.flexors
Mesenterium contains vessels and nervs
If there is a pus inside bursa synovialis the mesenterium vessels is comressed and pressure necrosis develops

The finger can’t be bended because of tendon necrosis. It needs endoplastic. Usually tendon of m.palmaris longus is used.

There are the different structure variants of bursa synovialis

Panaritium
Panaritium – purulent inflammation of finger.
Agent –streptococcus and staphilococcus

Localisation
Intradermal
Subdermal
Paronychia – paraungual panaritium
subungual
joint
osteal
tendinous
Pandactylitis is purulent inflammation of all finger tissues

Paronychia

Pandactylitis

Ttreatment (operation)
Anesthesia is local (Oberst’s Anesthesia)
Injection 2-4 ml of Lidocain (Novocain) to finger basis on each side.
2. Tourniquet to finger basis
3. Anesthesia begins in 4-7 min.

Incisions in case of Intradermal localisation
It is necessary to cut spalled Epithelial tissue

Incisions in case of subdermal localisation are fulfilled on each side between interdigital line and drainage.

Incisions in case of tendinous localisation are fulfilled on each side between interdigital line and drainage. Drainage doesn’t have to be through to not damage the mesenterium.

Operative [surgical] technique in case of osteal localisation may be different: necr(os)ectomy or amputation.