Smart Choices in Hand Surgery: Choosing the Right Incision

MedSync
Apr 14
2 min read

Updated: May 7

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:

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. However, with proper technique (elevation and not over-suturing), Bruner flaps are generally safe.

Match the Incision to the Injury

If the laceration is mid-finger, consider converting it into a Bruner flap. This adjustment maximizes exposure while preserving vascularity.

Assume Paired Injury

When a digital nerve is damaged, it's vital to assume the artery is too. Base your flap on the intact side for better perfusion. This approach will aid in recovery.

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.

Mark Before the Tourniquet

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

Additional Considerations in Hand Surgery

Hand surgery can be complex. Here are some additional tips for planning and executing incisions:

Understand the Anatomy

Knowing the underlying anatomy is crucial. Familiarize yourself with the muscles, tendons, and nerves in the hand. This knowledge will guide your incision placement and reduce the risk of damaging important structures.

Prepare for Complications

Be ready to adapt your plan if complications arise. Having a solid understanding of your techniques can help you manage unexpected challenges.

Focus on Patient Comfort

Always consider the patient's pain and recovery experience. A well-planned incision can lead to reduced post-operative discomfort and quicker healing times.

Continuous Learning

Surgical techniques evolve. Stay updated on the latest advancements in hand surgery. This commitment to ongoing education can enhance your skills and patient outcomes.