Arteries and nerves of the palm - Surgical anatomy of Dupuytren's disease

It has been reported that the skin of the palm is supplied by arteries receiving their blood from a radial, thenar, ulnar, or hypothenar arterial system. Interestingly, the middle of the palm has been described as hypovascularized, but detailed informations on number and distribution of blood vessels are not available. By surgical treatment of the Dupuytrens contracture we could show that preservation of the blood vessels and nerves supplying the skin leads to excellent postoperative results. However, our intraoperative observations do not correspond to the picture of a poorly vascularized region of skin in the middle of the hand. During surgical treatment we found between six and nine bundles consisting of one artery, at least one vene, and one nerve in each case. The bundles perforate the palmar aponeurosis through channels, and subaponeurotically a lot of them originate from further proximal than expected. This information should be taken into consideration during the exstirpation of the palmar aponeurosis.