Location of the Digital Neurovascular Bundle in Relation to a Mid-axial Incision Line: A Cadaveric Study

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Abstract
Background The digital mid-axial incision is commonly used in hand surgery. When correctly placed, the proper digital nerves should lie protected in the volar skin flap. The purpose of this study was to evaluate the distance of the digital neurovascular (NV) bundle from a mid-axial incision. Methods A standardized mid-axial incision along both sides of each digit was made on five fresh-frozen cadaver hands. The distance from the margin of the incision to the NV bundle was measured at the proximal interphalangeal joint (PIP) and the distal interphalangeal joint (DIP) levels on radial and ulnar sides. The same protocol was performed at the interphalangeal joint (IP) of each thumb. Results A total of 90 measurements were taken on five cadaveric hands. In the fingers, the average distance was 3.96 mm from the mid axial incision, with no measurement less than 2.97 mm. This distance was an average of 6.58 mm in the thumb, with no measurement less than 5.98 mm. The NV bundle on the radial side of the fingers was found to be farther from the mid axial incision than those on the ulnar side. The thumb displayed the opposite relationship, with the ulnar side having larger measurements. Conclusions The digital nerves of the fingers and thumb are safe during a mid-axial approach, with a safe zone of approximately 3mm in the fingers and 6mm in the thumb. Knowing these anatomic relationships will aid surgeons in safely approaching the digits while minimizing the risk of NV injury.

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