A modification of Henry's anterior approach to the humerus

A retrospective chart review identified patients who had surgery through Henry's standard anterior and anterolateral approaches to the humerus. Of the patients contacted, 62% had problems with the skin incision with reports of pain, numbness, and tingling around the scar. The frequency of cutaneous problems including neuroma prompted an anatomic study; the lower lateral cutaneous nerve branches to the arm were dissected in seven cadaver arms to determine their course. Henry's incision was then compared with a midline anterior incision. The cutaneous nerves were noticeably less numerous and smaller in diameter in the midline incision, probably related to the internervous, or watershed zone of cutaneous nerves in the anterior midline of the arm. Henry's standard intermuscular humeral exposure was no more difficult with the anterior midline incision. This study supports the notion that an anterior midline incision to approach the shaft of the humerus would minimize scar discomfort from cutaneous nerve injury.