A Simple Positioning Technique for Surgery on an Isolated Digit.

Flexible intraoperative positioning and exposure are key elements to enhance efficiency and success in hand surgery.[1] First proposed in 1948, the lead hand continues to represent the most commonly used positioning device due to its reusability, familiarity, and ease of use by an unassisted surgeon.[2] However, when frequent intraoperative repositioning or digit placement outside of the lead hand’s 2-dimensional plane is required, it can become quite cumbersome.[1] Techniques proposed to address this issue, such as using an OR glove to isolate the operative digit still require additional manipulation and may also become difficult.[1,3]

We describe here a simple technique using self-adherent tape (eg, 3M Coban) to isolate the involved digit, while overcoming the barriers of the lead hand mentioned above. The noninvolved digits are first placed in full flexion and are then secured to the palm with self-adherent tape such that the affected digit is left free and isolated (Figs. 1, 2). Should access to the palm be required, the tape can be easily and quickly removed and subsequently reapplied throughout a case.

Fig. 1.

The long finger is left in isolation with easy circumferential access by simply taping the remaining fingers to the palm with self-adherent tape.

Fig. 2.

Using self-adherent tape, the uninvolved fingers are wrapped to the palm providing unobscured access to the lateral aspect of the long finger.

We believe that this technique offers the following advantages over the lead hand: less bulk, exposure of the full circumference of the digit without interference from adjacent digits, the ability to manipulate the digit in a 3-dimensional capacity by a single surgeon, and facilitating isolation of the digit for fluoroscopy. In the authors’ experience, this technique is particularly useful when complete access to the digit or joint space is required (eg, hemi-hamate arthroplasty). We have found that sterile forms of the tape are readily available in both the operative suites and emergency departments of most centers. Disadvantages of this method compared with the lead hand include the inability to access proximal to the digit’s MCP joint, inability to check for rotational deformity while the wrap is in place (must verify once removed), and the inability to reuse the wrap for subsequent patients.

The lead hand continues to represent the standard positioning device for hand surgery; however, it may not offer adequate exposure in all situations. The described technique offers an alternative option in settings where a lead hand is not available or does not provide the optimal exposure and ease of access required for the given procedure.