Related Experiment Video
Updated: Jun 12, 2026

Vascularized Composite Hand Allograft Procurement and Preparation for Distal and Proximal Forearm Allotransplantation: A Stepwise Approach
Published on: May 23, 2025
[Palmar approach for silicone interposition arthroplasty of the finger middle joint]
Ali Ayache1, Christian K Spies2,3, Adrian Cavalcanti Kußmaul4,5
1Abteilung für Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland. ali.ayache@vulpiusklinik.de.
Objective:
The implantation of a silicone endoprosthesis at the middle finger joint through a palmar approach without harming the sensitive extensor aponeurosis.
Indications:
In cases of significant, treatment-resistant, functionally limiting symptoms and significant restriction of motion due to radiologically confirmed joint destruction of the middle finger joint.
Contraindications:
General surgical contraindications, markedly insufficient collateral ligament apparatus, axial malalignment in the coronal plane of more than 30°, absence of function in the flexor or extensor tendons, extensive osteolysis, contracted complex deformities.
Surgical Technique:
Modified palmar skin incision according to the Bruner technique. Mobilization of the ulnar and radial neurovascular bundles. Dissect and mobilize an intact tendon sheath distal to the A2 annulus, taking care to preserve the flexor tendons. Synovialectomy of the proximal interphalangeal (PIP) joint. Exposure and Resection of the proximal phalangeal head. Debridement of the former joint cavity. Dissection of the middle and proximal phalanges. Insertion of a trial prosthesis and reduction of the joint. If this reveals a good fit with free mobility and sufficient lateral stability with a physiological finger axis, the definitive implant can be inserted. Reconstruction of the tendon sheath.
Postoperative Management:
Fitting of a metacarpal brace, physiotherapist-guided mobilization, gradual increase in weight-bearing starting in the 7th postoperative week.
Results:
Follow-up examinations of silicone prosthesis implantations via the palmar approach at the finger PIP joint demonstrated clinical outcomes that were at least comparable to those known from the dorsal approach.
Related Concept Videos
Muscles of the Forearm that Move the Hand and Fingers
Anterior Compartment
The anterior compartment muscles originate from the humerus. They primarily function as flexors and are also known as flexor muscles. They typically insert on the carpals, metacarpals, and phalanges. The superficial layer includes the flexor carpi radialis,...
Spinal Nerves: Plexus I
The Cervical Plexus
The cervical plexus, formed by the anterior rami of the first four...
Bones of the Upper Limb: Ulna
Muscles that Move the Forearm
Forearm Flexors
The biceps brachii, brachialis, and brachioradialis are forearm flexors. The biceps brachii is made up of two heads. Its long head originates at the supraglenoid tubercle of the scapula, whereas that of the short head is...
Bones of the Upper Limb: Radius
The radius has a nail-shaped head, and a short...
Development of the Limb Synovial Joints
The mesenchymal stem cells differentiate into chondrocytes that form the hyaline cartilage, and later the cartilaginous model of the bone. This model further transforms into a bone. This process is known as endochondral ossification.
During development, the limbs...

