Purpose
Grayson ligament has been described as a common pathway for digital contracture in
Dupuytren disease. Its anatomical descriptions in the literature are, however, inconsistent.
Methods
We have performed a microsurgical dissection study in 20 fresh-frozen and thawed digits
to revisit the anatomy of Grayson ligaments. We also performed dissections in Thiel-preserved
hands to be able to study the changes in tension of the ligaments during flexion and
extension of the finger.
Results
We found the ligaments originally described by Grayson to be the best developed part
of a trabecular network of fibers, originating in continuity with the outer adventitial
layer of the flexor tendon sheath and running toward their insertions into the skin
in multiple planes, all volar to the neurovascular bundle. The most dorsal fibers,
which cover the neurovascular bundles, form a chevron shape with its midline apex
pointing distally in an extended finger. During flexion, the fibers become more transversely
oriented.
Conclusions
We found Grayson ligament comprises a trabecular network of fibers, instead of a ligament,
with a dynamic fiber orientation on the volar side of the finger. The main function
of this network of fibers seems to be the stabilization of the skin and fat pad in
digit extension while the relaxation in flexion allows the skin and volar fat pad
to adapt optimally to the form of the object that is held.
Clinical relevance
The new insights in the anatomy of Grayson trabecular network of fibers may be of
importance in the understanding of the pathological anatomy of Dupuytren disease.
Key words
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References
- The anatomy of Dupuytren's disease.in: McFarlane R.M. McGrouther D.A. Flint M. Dupuytren's Disease: Biology and Treatment. Churchill Livingstone, Edinburgh1990: 55-72
- Dupuytren's contracture.in: Green D.P. Hotchkiss R.N. Pederson W.C. Green's Operative Hand Surgery. 5th ed. Elsevier Churchill Livingstone, Philadelphia2005: 159-185
- The cutaneous ligaments of the digits.J Anat. 1941; 75: 164-165
- Patterns of the diseased fascia in the fingers in Dupuytren’s contracture. Displacement of the neurovascular bundle.Plast Reconstr Surg. 1974; 54: 31-44
- The preservation of the whole corpse with natural color [in German].Ann Anat. 1992; 174: 185-195
- Retaining Ligaments of the Digits of the Hand: Gross and Microscopic Anatomical Study.WB Saunders, Philadelphia1968
- Cutaneous ligament of the phalanges.J Anat Physiol. 1878; 12: 524.2-527
- Biomechanics of the membranous flexor tendon sheath: the role of Grayson's ligaments.Plast Reconstr Surg. 2006; 117: 497-506
- Cleland’s and Grayson’s ligaments of the hand: a morphometrical investigation.Clin Anat. 2007; 20: 68-76
Article info
Publication history
Published online: August 28, 2018
Accepted:
July 11,
2018
Received:
November 14,
2017
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
