The Triradiate Incision

An incision for improved exposure of circumscribed problems is described. “A direct approach providing good exposure and clear vision of the structures being operated upon is a basic principle of good surgery ” (Bruner, 1967). This principle, however, is being ignored in circumscribed problems such as tumours in the hand. In the forearm and most areas on the dorsum of the hand the skin is mobile and traditional incisions give good exposure to circumscribed problems. On the palmar aspect of the hand and wrist and over the dorsum of the distal phalanx the skin is taut. With linear incisions adequate exposure is difficult and often is obtained at the expense of too vigorous retraction. This article describes a triradiate incision to improve exposure in circumscribed problems (Figure 1). The Incision A dot is made over the centre of the area to be exposed and the three legs of the incision are drawn from it with a marking pen (Figure 1). The length of the legs and the angles between them is determined by what is needed to obtain adequate exposure. For tumours that take on a longitudinal configuration two triradiate incisions can be put together (Figure 2). Giant cell tumour of tendon sheath often infiltrates extensively about the distal joint. In these cases a triradiate incision can be made dorsally and volarly and connected around the border of the finger. If the two volar digital arteries are preserved in the dissection and a one half centimetre bridge of skin is left intact, the distal tissue will survive. Material and Results The incision was first used in 1974. Since then two hundred and fifty three patients have been operated. The only problem encountered has been necrosis of skin in removing ganglia over the distal phalanx. The largest necrotic area has been two millimetres at the tip of the incision and has healed in all instances by secondary intention with a pleasing cosmetic result. Discussion Review of the literature revealed that others have used a similar incision. Swanson uses a T-shaped incision to expose the distal joint for fusion (Swanson, 1979). Fig. la A dot is made over the area to be exposed and the three legs of the incision are drawn from it