The surface anatomy of the flexor tendon system (with reference to selecting optimal sites for mini-incisions)

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ZONES

As described in the JHS in May 2012 the palm and fingers can be divided into 4 zones A, B, C AND D divided by the finger creases. Each of these zones is further subdivided into thirds leading to the term “rule of thirds”.

(Note that Wilhelmi et al described the measurement of zone 1 to be similar to zone 2.)

PULLEYS, DECUSSATION AND CAMPERS CHIASM

The A2 pulley extends across the distal third of zone A and the proximal third of zone B.
The C1 pulley is located in the middle third of zone B.
The A4 pulley is located in the middle third of zone C
The A1 pulley is located at the proximal extent of zone A.
The A3 pulley lies just deep to the PIP crease and A5 just deep to the DIP crease.
The decussation of FDS occurs between the A1 and A2 pulleys and Camper’s chiasm lies in the middle third of zone B.

INCISIONS

This information allows us to plan small transverse palm and finger incisions in optimal locations that preserve the pulley system and these are shown here

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