Hand Exploration - Screenshot This!

Common Wound Extensions For The Hand & Wrist

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Choosing the right incision to extend a wound can significantly impact the ease and success of your procedure. Here’s how to make smarter choices in hand surgery:

1. Be Flexible with Incision Types

While it’s good to have a preferred approach—like mid-axial (volar), Bruner, hemi-Bruner, or a curvilinear dorsal incision—adaptability is key.

Pro tip: A volar mid-axial incision avoids flap tip necrosis more reliably than a Bruner, though with proper technique (elevation and not over-suturing), Bruner flaps are generally safe.

2. Match the Incision to the Injury

If the laceration is mid-finger, consider converting it into a Bruner flap to maximise exposure and preserve vascularity.

3. Assume Paired Injury

If a digital nerve is damaged, assume the artery is too. Base your flap on the intact side for better perfusion.

4. Plan for Proximal Access

Always plan incisions with potential proximal extension in mind. For example, if you're exposing the FDS and it’s not visible distally, a well-placed initial incision will allow easy proximal extension without compromising exposure.

5. Mark Before the Tourniquet

Use a marker to plan your incisions before inflating the tourniquet. This minimizes ischemic time and improves accuracy.

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