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DORSAL APPROACH TO THE METACARPOPHALANGEAL JOINT

USES

This approach is used to gain access to the extensor tendons at the level of the metacarpophalangeal (MCP) joint and to treat pathology of the MCP joint.

ADVANTAGES

The approach lies directly over the area of interest with few intervening structures.

DISADVANTAGES

The surgical incision lies immediately over the extensor tendons, which can cause scarring and adhesions of the tendons. In using this incision for MCP arthroplasty, especially in rheumatoid patients, there is very little tissue covering the implants, placing them at risk of becoming infected.

STRUCTURES AT RISK

Structures at risk include the extensor tendons and sagittal bands. Failure to repair the sagittal bands results in subluxation of the extensor tendon. Also at risk are the dorsal sensory nerve branches.

TECHNIQUE

When approaching all of the MCP joints, which is often the case in reconstructive procedures in the rheumatoid hand, a transverse incision is made across the distal metacarpal, approximately 1 cm proximal to the prominences of the metacarpal heads. Dorsal veins and sensory nerve branches are identified and preserved. The skin and subcutaneous fat layer should be elevated together as a single-layered flap, exposing the extensor tendons and sagittal band. The sagittal band is released on the radial side of the MCP joint and retracted ulnarly. This exposes the dorsal capsule of the MCP joint, which is opened with a longitudinal incision.

TRICKS

Related posts:

Volar Approach to the Basal Joint of the Thumb (for Bennett’s Fracture) Paronychium Approach Anterior Approach Deltopectoral Approach Posterior Approach Anterior Approach to the Cervical Spine

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