Drainage of the Medial (Midpalmar) Space
Incision
Make a curved transverse incision on the palm just proximal to the distal palmar crease and over the swelling. The length of the incision should be determined by the size of the abscess to be drained (Fig. 5-80).
Internervous Plane
There is no internervous plane in this approach.
Superficial Surgical Dissection
Incise the skin carefully; the line of the skin incision crosses the paths of the digital nerves. Open the palmar fascia by blunt dissection at the distal end of the wound and identify the long flexor tendon to the ring finger. Enter the medial midpalmar space by blunt dissection on the radial border of this tendon (Figs. 5-81 to 5-83).
Dang
Nerves
The digital nerves to the little and ring fingers run immediately under the palmar aponeurosis and cross the line of the skin incision. No part of the palmar aponeurosis should be incised transversely until these nerves have been dissected out fully (see Fig. 5-82).
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Figure 5-80 Incision for drainage of the medial space (midpalmar space).
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Figure 5-81 Open the palmar fascia by blunt dissection at the distal end of the wound.
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Figure 5-82 The flexor digitorum superficialis tendon to the ring finger is identified. The neurovascular structures run parallel to it on each side, and the lumbrical is visible on its radial side.
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Figure 5-83 The deep palmar space is entered by retracting the lumbrical and its tendon medially.
Vessels
The digital arteries run with the digital nerves and also may be in danger. For this reason, the digital arteries should be identified before the palmar aponeurosis is incised.
How to Enlarge the Approach
The incision, which is a drainage procedure, cannot be extended usefully.
