The Overall Distribution Pattern of the Hand’s Cutaneous Nerves and Its Clinical Implications in Sensory Reconstruction

SUMMARY: The objective of this study was to reveal the overall distribution pattern of the hand’s cutaneous nerves to provide a morphological basis for the selection and matching of the hand skin for sensory reconstruction during flap transplantation. The hands of 12 adult cadavers were used for the study. Palmar region and dorsum of the hand were divided into regions I-VI. The skin of the hand containing subcutaneous fat was removed close to the muscle surface. The modified Sihler’s staining method was used to visualize the overall distribution pattern of the cutaneous nerves and the areas they innervate. The median nerve, superficial branch of the ulnar nerve, and the superficial branch of the radial nerve innervated 59.27 % (containing 4.65 % of the palmar cutaneous branch of the median nerve), 36.91 %, and 3.82 % of the palm area, respectively. The superficial branch of the radial nerve, the dorsal branch of the ulnar nerve, and the median nerve innervated 45.16 %, 47.25 %, and 7.59 % of the hand’s dorsal skin area, respectively. Communication was found between the arborized branches of these cutaneous nerves. Region III of the palm and region VI of the dorsum of the hand had relatively more dense nerve distribution. Except for region V, the density of the total nerve branches in each palm region was higher than that of the dorsum of the hand. The total number of nerve branches in the distal phalanx and dorsum decreased from the thumb to the digitus minimus. Our results provide morphological guidance when designing a reasonable matching flap to improve the hand’s sensory function reconstruction.