Defining The Histological Support Structures Of The Digital Webspace: New Anatomy And Clinical Applications.
Sammy Dowlatshahi, MD1, Joseph Upton, MD1, Frank Willard, MD2, Stephanie Francalancia, BA1, Gary Fudem, MD3.
1Harvard Medical School, Boston, MA, USA, 2University of New England, Biddeford, ME, USA, 3University of Massachusetts Medical School, Worcester, MA, USA.
PURPOSE:Deformity of the digital web space is commonly encountered and can be congenital or acquired. Its correction requires an understanding of the normal anatomy, which is poorly understood, and understudied. The challenge to re-create a web space normal in appearance and function are equally difficult. The purpose of this study is to introduce previously unreported ligamentous structures of the digital web space.
METHODS: Forty web spaces were microsurgically dissected in twenty cadaveric hands. Select H&E, Trichrome and Elastin stains were obtained. Anatomic observations were made and correlated with intraoperative findings as they relate to burn reconstruction and congenital syndactylies.
RESULTS:Formed by a relatively large, three-dimensional inclined triangle extending from the distal palm to the dorsal metacarpophalangeal joint, the appearance of the web space and its functional demands are completely interdependent. The dynamically changing planes and contours of the web space are the result of a complex subcutaneous endoskeleton consisting of dense fibrous attachments between the palmar and dorsal skin along the whole length and width of the web spaces extending into the fingers in continuity with Cleland's and Grayson's ligaments. These tethers are so strong that one can lift the hand up by holding onto them, yet they are flexible enough to allow for finger abduction and adduction.
CONCLUSION:The digital webspace is more than skin and fat. A newly described ligamentous framework defines its shape and function. We will discuss the importance of preserving or re-creating this anatomy, and its significance in the management of congenital deformities.
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