No Man's Land

Medical Topic of the Day:  Many people like to celebrate the birth of our country by blowing up a small chunk of it.  Before you go overboard with those fireworks and explosives I thought it would be appropriate to discuss hand anatomy and why our hands are so precious.  We are talking about an area of your hand that plastic hand surgeons call  "No Man's Land."

Off The Top of My Head: A human hand is a beautifully complex assortment of nerves, tendons, skin and vessels. A perfect blend of bone and flesh. They can do amazing things and are extremely rugged for most purposes.

A human hair is about 100 microns thick and the human fingertip can sense up to 5 microns of imperfection on a surface. That isn't even an imperfection you can see. Your grip strength on the same fingertips can hold hundreds of pounds of weight. That's not just amazing, and when you consider the dexterity and rang of motion it's miraculous. We often take our hands for granted until we injure them.

We should be careful. Most superficial injuries to the hand heal without difficulty but there is a limit to the damage that can be repaired even with state-of-the-art medical technology. Hand surgeons call this area of the hand "No Man's Land" because a deep injury to this area of the hand almost always leaves permanent dysfunction.

The space between the red lines.

My Research Today:  We are talking about the palmar surface between the middle of your fingers to just below the middle of your palm.  It is a big area and a very common place for lacerations and crush injuries.

Holy crap that is a lot of stuff.

It isn't hard to understand why anything in this area is difficult to repair.  Look at all the stuff in there.  That is a lot of tendons, muscles, nerves, the sheaths covering those tendons and nerves, etc.  There isn't a lot of space for scar tissue either.  Even a tiny amount could cause a permanent deficit.

There is lot of shit in there and damage can't always be repaired successfully.  In fact a disruption to deep tissue in this area leaves permanent damage regardless of the skill of the surgeon or the surgical techniques used.

No be kind to your hands this holiday and don't hold on to any firecrackers.  Remember you might be able to grow an extra ear on the side of a rat but not a finger.  At least not yet.

Quest To 180:
Day off today.  Hey, it's a holiday.

The MAN:
Working on it.  Not feeling it today.