4. TOPOGRAPHIC ANATOMY AND OPERATIVE SURGERY OF THE REGION OF THE HAND

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Topics of the lesson: The region of the hand: topography of the palm and dorsum of the hand; fascial-cellular formations and their relationship with neighboring regions; blood supply and innervation of the region; projection of the arterial arches; synovial and bone-fibrous sheaths of finger flexor tendons. Purulent processes of hand and digits: classification; local anesthetic methods; cuts for drainage.

4.1. Highlight the palm region in Fig. 4.1, name the borders.

Superior_

Inferior_

Fig. 4.1. External landmarks of the palm region

4.2. Draw on the Fig. 4.1 the projections of superficial and deep palmar arterial arches, median nerve and the forbidden zone of Kanavel.

4.3. List the layers of the palm region of the hand:

1. Skin -_

2__

3. _

4. _

5. _

6. _

7. _

8. _

9. _

10. _

11. _12. _

4.4. Using Fig. 4.2, name the arteries forming superficial and deep arterial arches and sign them in the Fig.:

Fig. 4.2. Arterial blood supply of the palm

4.5. Fill in the table using Fig. 4.3. Name what forms the fascial compartment of the hand that passes through them.

Fig. 4.3. The transverse section of the wrist

NAME	WALLS	CONTENT
Middle compartment of palm	Anterior - Posterior - Medial - Lateral -	Tendons: Arteries: Nerves: Muscles:
Lateral compartment of palm	Anterior - Posterior - Medial - Lateral -	Tendons: Muscles:
Medial compartment of palm	Anterior - Posterior - Medial - Lateral -	Muscles:

4.6. Using Fig. 4.4, fill in the table.

Fig. 4.4. Puncture of the wrist joint

puncture of the wrist joint
1. Indications:	-
2. Limb position:
3. Type of anesthesia:
puncture of the wrist joint
4. The point of puncture:	Direction of needle:
The intersection points of the lines: А - B -
External reference points:
а) bones: 1. 2.
b) tendons: 3. 4.

4.7. Explain the situation in this clinical case.

As a result of the corn abscess of the 2nd interdigital space, the pus has spread into the palm commissural opening. In what layer is the abscess located now?

Specify the ways of further spread of purulent leak (distal, proximal).

4.8. In Fig. 4.5, draw lines to indicate incisions in the subcutaneous felon (panaritium) of the middle and distal phalanges and in the commissural phlegmon.