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Lines of Relative Motion of Neutrality as a Guide for Lateral Zig-Zag Skin Incision: A Proof-of-Concept Study
Anna D Lee, MD
1, Christopher Kubajak, MD
2; David T.W. Chiu, MD
1(1)NYU Langone Health, New York, NY, (2)University of Kentucky, Lexington, KY
INTRODUCTIONThe mid-lateral "Bunnell" incision is widely used in digital surgery due to its reliable exposure while preserving the neurovascular bundles. However, the technique is very surgeon-dependent, where miniscule movements of the incision may create profound impacts on the outcome and contracture rates. The senior author introduces a novel incision technique based on the lines of relative motion neutrality - zones of minimal skin deformation during finger flexion and extension. This study evaluates whether incisions along these natural lines may improve postoperative skin mobility when compared to the Bunnell incision.
MATERIALS & METHODSThis proof-of-concept study was performed on two hands. With each digit in full flexion, a felt-tip marker was used to paint the volar surfaces of apposed skin on the radial or ulnar side of each digit in full flexion. Upon extension, this generates a natural zigzag marking representing the proposed incision path. A standard mid-lateral Bunnell incision served as a control. Each incision was divided into six segments (seven points) and measured using a compass and ruler. The difference in total lengths during flexion and extension served as a proxy for dynamic skin mobility. Data were analyzed using R Studio.
RESULTSA total of 340 measurements were collected across both hands. Across all digits, the motion-guided incision demonstrated smaller changes in total length during flexion-extension for the index (0.30cm vs 0.75cm), long (0.33cm vs 1.03cm), ring (0.33cm vs 0.85cm), small (0.35cm vs 0.65cm) and thumb (0.25cm vs 0.35cm), when compared to the Bunnell control (Figure 1).
CONCLUSIONSThis proof-of-concept study suggests that aligning incisions along lines of relative motion neutrality may reduce dynamic tension on the skin, potentially minimizing scar contracture and improving functional outcomes. These findings support further exploration of this technique in vivo to assess its potential to reduce postoperative contracture and enhance functional outcomes.
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