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Nerval danger zones for surgical procedures of the arm and the forearm
Author(s) -
Hirtler Lena,
Wlodek Vincent
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.748.2
Subject(s) - medicine , forearm , wrist , anatomy , cutaneous nerve , radial nerve , dorsum , posterior interosseous nerve , median nerve , carpal bones , elbow , upper limb , alternative medicine , pathology , palsy
The course of cutaneous nerves at the distal forearm, the wrist joint and the hand is highly variable. This variability can cause complications in the different standardized surgical approaches for surgical interventions in these regions. The aim of this study was therefor (1) to document the courses of the lateral, medial and posterior antebrachial cutaneous nerves, the superficial branch of the radial nerve, the dorsal branch of the ulnar nerve and the palmar branches of the median and ulnar nerve and (2) to determine their relationship to osseous and tendinous landmarks. Afterwards danger zones for surgical approaches will be defined. Materials and methods The cutaneous nerves were dissected on 20 formalin/phenol – embalmed forearms and hands of anatomical specimens. The position and distribution of the nerves as well as landmarks were documented and distances were measured at pre‐determined positions. Results Palmar danger zone in a proximal to distal course: 10 cm proximal to the wrist joint: between 0 – 20%, 40 – 66,67 %, 80 – 86,67% and 93,34 – 100% of the width of the forearm; 5 cm prox. to the wrist: 0 – 26,67 %, 53,34 – 66,67 % and 86,7 – 100 % of the width; on the line between the styloid processes: 0 – 13,33 %, 20 – 26,67 % and 93,34 – 100% of the width; on the line between the distal border of the pisiform bone and the base of the first metacarpal bone: 0 – 20 %, 46,67 – 60 % and 66,67 – 73,33% of the width. Dorsal danger zones in a proximal to distal course: 10 cm prox. to the wrist: 0 – 6,67 %, 13,34 – 33,33 %, 40 – 66,67 % and 93,33 – 100 % of the width; 5 cm prox. to the wrist: 0 – 6,67 %, 20 – 60 % and 66,67 – 73,33% of the width; on the line between the styloid processes: 0 – 20 %, 73,33 – 80 % and 93,33 – 100 % of the width; proximal metacarpus: 0 – 40 %, 73,33 – 86,67 % and 93,33 – 100 % of the width; on 50% of the metacarpal height: 0 – 6,67%, 13,33 – 33,33 %, 46,67 – 53,33 %, 66,67 – 86,67 % and 93,33 – 100 % of the width; distal metacarpus: 0 – 5 %, 25 – 35 %, 50 – 65 %, 75 – 85 % and 95 – 100 % of the width. The anatomic snuffbox and the ulnar aspect of the wrist were considered to be not safe, because of the wide distribution of nerves. Conclusion Aberrant and normal courses of the cutaneous nerves were documented and described in detail. Based on the results of this study, specific danger zones were defined to further help refining surgical procedures in future. Support or Funding Information no funding was provided.