The dorsum of the hand: focus on topographic anatomy
Keywords:
Hand dorsum, topographic anatomy, hand ageing, aesthetic medicineAbstract
Introduction: The anatomy of the hand has traditionally been described primarily from a functional standpoint. However, aesthetic and anti-ageing interventions for hand rejuvenation require a precise and comprehensive understanding of anatomy. Recent investigations into hand anatomy have been conducted with greater methodological refinement than earlier studies, as classical cadaveric dissections are now complemented by high-resolution ultrasonography and other advanced imaging modalities. These approaches have led to the identification of previously unrecognised anatomical features.
Objectives: The purpose of the present study is to provide a detailed description of the topographic anatomy of the dorsal aspect of the hand, with a particular focus on its clinical relevance for physicians performing aesthetic and age-related procedures. The analysis was deliberately restricted to the dorsum of the hand, which represents the most common site of minimally invasive rejuvenation techniques.
Methods: In addition to standard anatomical reference texts, we conducted a systematic search of PubMed-indexed literature using the terms ‘hand dorsum’ combined with ‘topographic anatomy’, ‘hand ageing’, and ‘aesthetic medicine.’ Thirty relevant publications, published between 1933 and 2023, were identified.
Results: The topographic anatomy of the dorsum of the hand can be conceptualised as a multilayered arrangement of overlapping structures. These layers are separated by vertical fibrous septa that delineate compartments containing critical anatomical elements such as tendons, vascular branches, and neural structures.
Conclusions: A detailed description of this layered configuration is provided in the following sections.
References
1. Kanavel AB. Infections of the Hand: A Guide to the Surgical Treatment of Acute and Chronic Suppurative Processes in the Fingers, Hand and Forearm. JAMA. 1933; 101(27):2141.
2. Anson BJ, Wright RR, Ashley FL, Dykes J. The fascia of the dorsum of the hand. Surg Gynecol Obstet. 1945, 81:327-331.
3. Bidic SM, Hatef DA, Rohrich RJ. Dorsal hand anatomy relevant to volumetric rejuvena-tion. Plast Reconstr Surg. 2010; 126(1):163-168.
4. Kim JS. Detailed Sonographic Anatomy of Dorsal Hand Augmentation With Hyaluronic Acid and Calcium Hydroxyapatite Fillers. Aesthet Surg J. 2019; 39(10):1096-1106.
5. Frank K, Koban K, Targosinski S, et al. The Anatomy behind Adverse Events in Hand Volumizing Procedures: Retrospective Evaluations of 11 Years of Experience. Plast Re-constr Surg. 2018; 141(5):650e-662e.
6. Hung YT, Cheng CY, Chen CB, Huang YL. Ultrasound Analyses of the Dorsal Hands for Volumetric Rejuvenation. Aesthet Surg J. 2022; 42(10):1119-1126.
7. Kim JS, Lee W, Oh W, Park JA, Yang EJ. Identification of a suitable layer for injecting calcium hydroxylapatite fillers in the hands. J Plast Reconstr Aesthet Surg. 2021; 74(4):866-873.
8. Oltulu P, Ince B, Kokbudak N, Findik S, Kilinc F. Measurement of Epidermis, Dermis, and Total Skin Thicknesses from Six Different Body Regions with a New Ethical Histo-metric Technique. Turkish Journal of Plastic Surgery. 2018; 26(2):56-61.
9. Park JA, Lee SH, Hwang SJ, Koh KS, Song WC. Anatomic, histologic, and ultrasound analyses of the dorsum of the hand for volumetric rejuvenation. J Plast Reconstr Aesthet Surg. 2021; 74(7):1615-1620.
10. Har-Shai L, Ofek SE, Lagziel T, et al. Revitalizing Hands: A Comprehensive Review of Anatomy and Treatment Options for Hand Rejuvenation. Cureus. 2023; 15(2):e35573.
11. Lefebvre-Vilardebo M, Trevidic P, Moradi A, Busso M, Sutton AB, Bucay VW. Hand: Clinical Anatomy and Regional Approaches with Injectable Fillers. Plast Reconstr Surg. 2015; 136(5 Suppl):258S-275S.
12. Kim JS. Changes in Sonographic Thickness with Identification of Nine Layers, Rough-ness, and Hydration in the Dorsal Hand after Injectables. Plast Reconstr Surg. 2023; 152(6):1212-1225.
13. Zhou J, Xie Y, Wang WJ, et al. Hand Rejuvenation by Targeted Volume Restoration of the Dorsal Fat Compartments. Aesthet Surg J. 2017; 38(1):92-100.
14. de Rezende MR, Mattar Júnior R, Cho AB, Hasegawa OH, Ribak S. Anatomic study of the dorsal arterial system of the hand. Rev Hosp Clin Fac Med Sao Paulo. 2004; 59(2):71-76.
15. Tan RES, Lahiri A. Vascular Anatomy of the Hand in Relation to Flaps. Hand Clin. 2020; 36(1):1-8.
16. Nayak SB, Kumar N, Aithal Padur A, Shetty SD. Variant Superficial Branch of Radial Artery along with Supplementary Tendons on the Dorsum of the Hand and Their Surgical Implications. Case Rep Surg. 2016; 2016:9581759.
17. Poirot Y, Duparc F, Hue AG, Gandolfi S, Dacher JN, Auquit-Aukbur I. Cutaneous vas-cularization of the proximal two-thirds of the dorsal aspect of the hand: descriptive ana-tomical study of a perforating arterial arch. Surg Radiol Anat. 2023; 45(9):1073-1081.
18. Wagner T, Hummelink S, Mathot F, Ulrich D. The anatomic relationship of dorsal arterial perforators of the distal forearm, wrist, and dorsum of the hand with conclusions for the clinic. J Plast Reconstr Aesthet Surg. 2023; 83:141-147.
19. Forstmeier V, Sorg H, Kabbani M, Herold C, Altintas MA, Krämer R. Evaluation der ku-tanen Mikrozirkulation des Handrückens im Alter - Implikationen für die Wundheilung in der Handchirurgie? [Evaluation of Cutaneous Microcirculation at the Dorsum of the Hand within Different Age Groups - Implications for Wound Healing in Hand Surgery?]. Handchir Mikrochir Plast Chir. 2015; 47(6):384-388.
20. Zhang SX, Schmidt HM. Clinical anatomy of the subcutaneous veins in the dorsum of the hand. Ann Anat. 1993; 175(4):381-384.
21. Sontakke B, Humbe V, Yannawar P. Dorsal hand vein authentication system: a review. Nigerian Journal of Botany. 2017; 6(5):511-514.
22. Navissano M, Malan F, Pisani M, Battiston B. Una alternativa microchirurgica: I lembi li-beri cutaneo-venosi. Riv Chir Mano. 2001 ;38(1):55-62.
23. Pan WR, Zeng FQ, Wang D, Qiu ZQ. A Method for Making a Lymphatic Specimen of the Dorsum of the Hand. Lymphat Res Biol. 2015; 13(4):275-278.
24. Georgiev GP, Landzhov B, Olewnik Ł, et al. Unusual sensory innervation of the dorsal hand and why we should bear this variation in mind. Folia Morphol (Warsz). 2023; 82(1):194-197.
25. Huanmanop T, Agthong S, Luengchawapong K, Sasiwongpakdee T, Burapasomboon P, Chentanez V. Anatomic characteristics and surgical implications of the superficial radial nerve. J Med Assoc Thai. 2007; 90(7):1423-1429.
26. Sulaiman S, Soames R, Lamb C. The sensory distribution in the dorsum of the hand: ana-tomical study with clinical implications. Surg Radiol Anat. 2015; 37(7):779-785.
27. Mok D, Nikolis A, Harris PG. The cutaneous innervation of the dorsal hand: detailed anatomy with clinical implications. J Hand Surg Am. 2006; 31(4):565-574.
28. Testut L, Jacob O. Anatomia Topografica. Vol. II, UTET, Torino. 1960, pp.809-817.
29. Campero M, Verdugo RJ, Ochoa JL. Vasomotor innervation of the skin of the hand: a contribution to the study of human anatomy. J Anat. 1993; 182 ( Pt 3)(Pt 3):361-368.
30. Hung YT, Huang YL. Dual real-time imaging of vein detector and ultrasound for a safe volumetric rejuvenation and skin surgery of the dorsal hand. J Am Acad Dermatol. 2021; 85(6):e339-e341.
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