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Neurovascular Anatomy

Hand neurovascular anatomy: variations (median artery, DCBUN), nerve loops, and implications for nerve/vascular repair & transfers.

43 citationsUpdated Sep 2026
Illustration: Neurovascular Anatomy

Overview

Neurovascular anatomy of the hand and wrist encompasses the nail bed, skin, fascia, compartments, palmar spaces, digits, and neurovascular structures [27]. Surgeons must identify and dissect the neurovascular bundle proximally and distally throughout its course to prevent injury in Dupuytren’s disease [1]. Palmar cutaneous branches of the digital nerves are a constant anatomical feature that can be mistaken for proper digital nerves, potentially leading to inadvertent injury [5]. Knowledge of anatomical variations of the posterior interosseous nerve is useful during operations in the vicinity of the nerve and when repairing nerve injuries [2]. Symptomatic neural loops are a rare, diagnostic challenge and diagnosis of exclusion; clinicians must be aware of this anatomic variation and consider microvascular decompression if other etiologies are absent [3].

The peripheral nervous system anatomy includes nerve fiber classification, receptor types, blood supply, and pharmacological agents affecting nerve function [8]. Tissues with low metabolic rates, such as tendons and nerves, are supplied by fewer small vessels and a disproportionate number of large vessels compared to metabolically active tissues [15]. Temporary or permanent interference with intraneural microcirculation may cause disturbances in nerve function [11]. Vascular insufficiency of the upper extremity requires a thorough understanding of vascular anatomy, diagnostic modalities, and medical and surgical management options [9]. Acute and chronic vascular disorders of the hand and wrist include ulnar artery thrombosis, embolic disease, aneurysms, Buerger disease, and vasospastic disease [47]. Vascular anomalies of the upper limbs involve significant advances in pathogenesis and genetics, classification systems, diagnosis and treatment [42].

Hand surgery principles emphasize the balance between restoring function and maintaining aesthetic appearance [40]. Restoration of full function remains unachievable despite advances in nerve transfers and microvascular free functioning muscle transfers [13].

Osseous Anatomy

The head of the proximal phalanx is particularly susceptible to vascular compromise [22]. This vulnerability arises because a nutrient vessel is often the only vessel supplying this region [22].

Ligaments and Joint Capsule

The thumb trapeziometacarpal joint ligaments exhibit a distinct innervation pattern that indicates a proprioceptive function in addition to their biomechanical importance [41]. Dorsal ligaments contain an abundance of nerve endings [41], whereas the anterior oblique ligament has little to no innervation [41].

Anatomical findings regarding the innervation of the proximal interphalangeal joint provide a basis for procedures to denervate the PIP joint [39].

Muscles and Tendons

Anomalous tendinous structures arising from the flexor digiti minimi can compress the medial half of the deep branch of the ulnar nerve [52]. This specific compression results in an unusual pattern of ulnar neuropathy [52].

Regarding peroneal anatomy, the distance from the peroneal tendons sheath to the sural nerve decreases from proximal to distal at the posterior tip of the fibula [28]. A 'high and inside' approach that remains superior to the superior border of the peroneus brevis tendon is anatomically safe [20]. This approach may decrease the chance of intraoperative nerve injury [20] and may decrease the chance of postoperative nerve irritation [20].

Neurovascular Anatomy

Median Nerve

A constant, identifiable vascular pedicle to the median nerve exists in the distal forearm [6]. This anatomical feature enables a dissection technique that achieves adequate mobilization of the median nerve while preserving its vascularity and facilitating tensionless repair [6]. At the wrist, the median nerve may be advanced while retaining the vascular connection and blood supply from the radial artery [4]. Advancing the median nerve at this location maintains the vascularity of the nerve at the common site of nerve repair in the distal forearm [4].

Digital and Palmar Nerves

Palmar cutaneous branches of the digital nerves constitute a constant anatomical feature [5]. These branches can be mistaken for proper digital nerves [5], and such misidentification can lead to inadvertent injury [5]. The Berrettini communicating branches are positioned consistently in the palm [14]. A high-risk zone in the palm fully contains seven of the 12 Berrettini connections [14]. Awareness of this high-risk zone for Berrettini connections helps reduce the risk of iatrogenic nerve injury [14].

Radial and Posterior Interosseous Nerves

Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury [7]. Knowledge of anatomical variations of the posterior interosseous nerve is useful during operations in the vicinity of the nerve [2] and when repairing nerve injuries [2].

General Neurovascular Principles and Variations

Clinicians must be aware of symptomatic neural loops as an anatomic variation [3]. Microvascular decompression should be considered for symptomatic neural loops if other etiologies are absent [3]. Anomalous muscles in the forearm can help explain various conditions of arterial and nerve dysfunctions which otherwise are thought to be idiopathic [37].

Vascular Anatomy and Pathology

The head of the proximal phalanx is particularly susceptible to vascular compromise due to reliance on a single nutrient vessel [22].

Biomechanics and Function

Median Nerve Vascularity and Mobilization The median nerve in the distal forearm possesses a constant identifiable vascular pedicle [6]. This anatomical feature allows surgeons to advance the median nerve at the wrist while retaining the vascular connection and blood supply from the radial artery [4]. A specific dissection technique enables adequate mobilization of the median nerve while preserving vascularity and achieving tensionless repair [6].

Neurovascular Bundle Pathology In Dupuytren’s disease, the neurovascular bundle spirals, requiring surgeons to identify and dissect it proximally and distally throughout its course to prevent injury [1]. Ischemic preconditioning of neural tissue makes nerves more susceptible to mechanical stimuli and injury [23].

Muscle Transfer Constraints In muscle transfer procedures, the neurovascular pedicle vessels are the predictable limiting factor for translation due to their shorter length compared to the nerve [48].

Anatomical Distances The distance from the peroneal tendons sheath to the sural nerve at the posterior tip of the fibula decreases from proximal to distal [28].

Nerve Repair Mechanics and Conduits Conduit-assisted primary digital nerve repairs with 8-0 suture increase the maximum load to failure compared with repairs with 9-0 suture [50]. Increasing the overall number of sutures in conduit-assisted primary digital nerve repairs increases the maximum load to failure [50]. The use of nerve conduits in large-diameter nerves may not yield the same success as in small-diameter nerves [21]. Nerve conduits and acellular nerve allografts offer tools for overcoming unexpected gaps, though their application is limited by poorly defined critical repair gap sizes and diameters [57].

Microvascular Access and Compression Searching for veins between the 3 to 5 o'clock or 7 to 9 o'clock positions during fingertip replantation at the eponychial level is feasible and presents a reliable option for microsurgeons [55]. The choice of cuff width for median nerve compression requires consideration of both occlusion pressure and electrophysiological changes in the nerve [56].

Common Sites of Injury

In Dupuytren’s disease, the neurovascular bundle spirals, requiring surgeons to identify and dissect it proximally and distally throughout its course to prevent injury [1]. Palmar cutaneous branches of the proper digital nerves are a constant anatomical feature in this surgery that can be mistaken for proper digital nerves, potentially leading to inadvertent injury [5]. Recognition of ulnar nerve anatomical details and variations is essential for accurate diagnosis and surgical decompression to avoid iatrogenic injury [12]. Similarly, anatomical variations of the posterior interosseous nerve are relevant during operations in the vicinity of the nerve and when repairing nerve injuries [2]. Symptomatic neural loops are a rare anatomic variation that can cause hemidigital anesthesia and require consideration of microvascular decompression if other etiologies are absent [3].

The median nerve at the wrist may be advanced while retaining the vascular connection and blood supply from the radial artery, maintaining vascularity at the common site of nerve repair in the distal forearm [4]. Vascular patterns of the palmar type of median artery as a source of the superficial palmar arch are important to hand surgeons [32]. Preconditioning of neural tissue by ischemic parameters makes nerves more susceptible to mechanical stimuli and injury [23]. Nerve damage is greatest in table saw lacerations compared to other simulated peripheral nerve lacerations [34].

Nerve injury after ballistic trauma to the upper extremity is common, with vascular injury and fractures associated with a higher risk of nerve injury [18]. Most median nerve lacerations should be repaired soon after injury, though many patients are left with permanent sequelae despite the widespread application of microsurgical techniques [19]. Early exploration of supracondylar fractures in children allows direct visualization of the extent of neurovascular injury and immediate intervention [10]. Patients with an injury pattern that may lead to nerve injury warrant prompt referral to an upper extremity specialist to optimize outcomes [29]. Posttraumatic changes in the central nervous system are possible reasons for observed functional disturbances in the uninjured nerve after median and ulnar nerve injury [30].

Surgical Anatomy

Median Nerve

Surgical dissection techniques exist that enable adequate mobilization of the median nerve while preserving its vascularity and achieving tensionless repair [6]. At the wrist, the median nerve may be advanced while retaining the vascular connection and blood supply from the radial artery [4]. Retaining this vascular connection from the radial artery helps maintain the vascularity of the nerve at the common site of nerve repair in the distal forearm [4].

Ulnar Nerve

Recognition of anatomical details and variations of the ulnar nerve is essential for accurate diagnosis and surgical decompression to avoid iatrogenic injury [12]. Topographic mapping data of the distal ulnar nerve and its peripheral branches may inform surgical techniques for nerve transfer [38]. Additionally, this topographic mapping data may aid surgeons in avoiding iatrogenic injury during distal decompression procedures [38].

Radial Nerve

No specific anatomical evidence is provided for this subsection in the current evidence base.

Digital Nerves

Palmar cutaneous branches of the digital nerves are a constant anatomical feature that can be mistaken for proper digital nerves [5]. Mistaking these palmar cutaneous branches for proper digital nerves can potentially lead to inadvertent injury [5]. Identifying and carefully managing the anatomic variant of dual radial digital nerves ensures a successful surgical outcome without neurologic compromise [24].

Palmar Anatomy

A high-risk zone in the palm was defined that fully contained seven of the 12 Berrettini connections [14]. All palm operations must be done with great care to visualize and protect unusual anatomical structures [14]. The central area of the palm contains a triangular zone which is poorly vascularized [33].

Neurovascular Bundles and Vessels

A 'high and inside' approach that remains superior to the superior border of the peroneus brevis tendon may decrease the chance of intraoperative nerve injury and irritation postoperatively [20].

Other Anatomical Structures

Symptomatic neural loops are a rare anatomic variation [3]. The motor branch to the fourth lumbrical (4L/3PI) can be localized intraoperatively based on anatomical characterization findings [26].

Key Evidence

  • [L4] Surgeons should identify and dissect the neurovascular bundle proximally and distally throughout its course to prevent injury. [1] (10.1177/1753193409349855)
  • [L4] Knowledge of anatomical variations is useful during operations in the vicinity of the nerve and when repairing nerve injuries. [2] (10.1054/jhsb.2000.0399)
  • [Case_report] Symptomatic neural loops are a rare, diagnostic challenge and diagnosis of exclusion; clinicians must be aware of this anatomic variation and consider microvascular decompression if other etiologies are absent. [3] (10.1016/j.jhsa.2012.07.012)
  • [L5] This cadaveric study suggests that it may be possible to advance the median nerve at the wrist while retaining the vascular connection and blood supply from the radial artery, and so maintain the vascularity of the nerve at the common site of nerve repair in the distal forearm. [4] (10.1016/j.jhsa.2012.03.028)
  • [Textbook] Palmar cutaneous branches of the digital nerves are a constant anatomical feature that can be mistaken for proper digital nerves, potentially leading to inadvertent injury. [5] (10.1007/978-3-642-22697-7_33)
  • [L2] The study established the presence of a constant identifiable vascular pedicle to the median nerve in the distal forearm and developed a dissection technique that enables adequate mobilization while preserving vascularity and achieving tensionless repair. [6] (10.1016/s0363-5023(09)60086-1)
  • [L5] Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury. [7] (10.1016/j.jhsa.2013.12.004)
  • [L5] Vascular insufficiency of the upper extremity requires a thorough understanding of vascular anatomy, diagnostic modalities, and medical and surgical management options, with promising advances continuing to be made in treatment. [9] (10.1016/j.jhsa.2010.06.011)
  • [L4] Early exploration of supracondylar fractures allows direct visualization of the extent of neurovascular injury and immediate intervention. [10] (10.1177/17531934231201925)
  • [L5] The article reviews the structure and function of intraneural microvessels and the pathophysiology of intraneural edema, emphasizing that temporary or permanent interference with intraneural microcirculation may cause disturbances in nerve function. [11] (10.2106/00004623-197557070-00011)
  • [L5] Recognition of these anatomical details and variations is essential for accurate diagnosis and surgical decompression to avoid iatrogenic injury. [12] (10.1016/j.hcl.2007.05.001)
  • [L5] Despite advances in nerve transfers and microvascular free functioning muscle transfers, restoration of full function remains unachievable. [13] (10.1016/j.jhsa.2014.06.126)
  • [L5] The Berrettini communicating branches were positioned consistently, and a high-risk zone in the palm was defined that fully contained seven of the 12 connections; awareness of this zone can help reduce the risk of iatrogenic nerve injury, though all palm operations must be done with great care to visualize and protect unusual anatomical structures. [14] (10.1177/17531934221095401)
  • [L5] Tissues with low metabolic rates, such as tendons and nerves, are supplied by fewer small vessels and a disproportionate number of large vessels compared to metabolically active tissues. [15] (10.2106/00004623-196143080-00010)
  • [L4] Nerve injury after ballistic trauma to the upper extremity is common, with vascular injury and fractures associated with a higher risk of nerve injury. [18] (10.1016/j.jhsa.2021.03.020)
  • [L5] Most nerve lacerations should be repaired soon after injury, and current widespread application of microsurgical techniques should lead to reasonable results in most individuals, though many patients do not have ideal outcomes and are often left with permanent sequelae. [19] (10.1016/j.jhsa.2014.01.025)
  • [L5] A 'high and inside' approach that remains superior to the superior border of the peroneus brevis tendon is anatomically safe and may decrease the chance of intraoperative nerve injury and irritation postoperatively. [20] (10.1177/0363546512448320)
  • [L4] The use of nerve conduits in large-diameter nerves should be carefully considered as they may not yield the same success as in small-diameter nerves. [21] (10.1007/s11552-008-9158-3)
  • [L5] This nutrient vessel is often the only vessel supplying the head of the proximal phalanx, making this area particularly susceptible to vascular compromise. [22] (10.1016/j.jhsa.2022.09.014)
  • [Paper] This study provides the first concrete evidence that the preconditioning of neural tissue by ischemic parameters makes nerves much more susceptible to mechanical stimuli/injury. [23] (10.1016/s0363-5023(09)60085-x)
  • [L4] Identifying and carefully managing this anatomic variant ensured a successful surgical outcome without neurologic compromise. [24] (10.1016/j.jhsg.2025.100906)
  • [L5] These findings provide a guide for intraoperative localization of the 4L/3PI motor branch and may explain findings seen after distal nerve transfers. [26] (10.1016/j.jhsa.2024.11.023)
  • [L5] This cadaveric study shows that the distance from the peroneal tendons sheath to the sural nerve decreases from proximal to distal. [28] (10.1007/s00167-019-05438-x)
  • [L3] Patients with an injury pattern that may lead to nerve injury warrant prompt referral to an upper extremity specialist in an effort to optimize outcomes. [29] (10.1177/1558944719866865)
  • [L3] Posttraumatic changes in central nervous system are the possible reasons for the observed functional disturbances in the uninjured nerve. [30] (10.1016/j.jht.2016.10.006)
  • [L4] These vascular patterns are important to hand surgeons. [32] (10.1007/s11552-009-9197-4)
  • [L5] The central area of the palm contains a triangular zone which is poorly vascularized. [33] (10.2106/00004623-195436060-00012)
  • [L5] Nerve damage was greatest in table saw lacerations. [34] (10.1016/j.jhsg.2025.100833)
  • [L4] These variations should also be kept in mind as they could help explain various conditions of arterial and nerve dysfunctions which otherwise are thought to be idiopathic. [37] (10.1007/s11552-007-9033-7)
  • [L5] These data may potentially inform surgical techniques for nerve transfer and aid surgeons in avoiding iatrogenic injury during distal decompression procedures. [38] (10.1177/15589447241306151)
  • [L5] These findings provide an anatomical basis for procedures to denervate the PIP joint. [39] (10.1016/j.jhsa.2018.07.014)
  • [L5] The thumb trapeziometacarpal joint ligaments had an abundance of nerve endings in the dorsal ligaments but little to no innervation in the anterior oblique ligament, inferring a proprioceptive function of these ligaments in addition to their biomechanical importance. [41] (10.1016/j.jhsa.2011.12.038)
  • [L5] This article aims to provide an update on vascular anomalies relevant to the upper limbs, focusing on significant advances in pathogenesis and genetics, classification systems, diagnosis and treatment. [42] (10.1177/1753193418808130)
  • [L5] In muscle transfer, the neurovascular pedicle vessels are the predictable limiting factor for translation due to their shorter length compared to the nerve. [48] (10.1016/j.jse.2014.07.001)
  • [L5] Conduit-assisted primary digital nerve repairs with 8-0 suture increases the maximum load to failure compared with repairs with 9-0 suture, as does increasing the overall number of sutures. [50] (10.1177/1558944718769382)
  • [Case_report] This case describes a rare lesion where an anomalous tendinous structure from the flexor digiti minimi compressed the medial half of the deep branch of the ulnar nerve, resulting in an unusual pattern of ulnar neuropathy. [52] (10.2106/00004623-199603000-00015)
  • [L4] The anatomic study and clinical experience demonstrate that searching for veins between the 3 to 5 o'clock or 7 to 9 o'clock positions is feasible and presents a reliable option for microsurgeons, offering adequate venous drainage with reduced operating time. [55] (10.1177/1753193413490653)
  • [L4] This suggests that while choosing the appropriate width of the cuff, both occlusion pressure and electrophysiological changes in nerve should be kept in mind. [56] (10.1186/1749-799x-3-1)
  • [L4] Nerve conduits and acellular nerve allografts offer efficient tools for overcoming unexpected gaps, though their application is limited by poorly defined critical repair gap sizes and diameters. [57] (10.1007/s11552-014-9601-6)

See Also

References

[1] Spiralling of the neurovascular bundle in Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409349855

[2] Variations of the Posterior Interosseous Nerve. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0399

[3] Symptomatic Neural Loop Causing Hemidigital Anesthesia: Case Report. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.07.012

[4] The Vascularization of the Median Nerve in the Distal Forearm and Its Potential Clinical Importance. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.03.028

[5] 33. Palmar Cutaneous Branches of the Proper Digital Nerves Encountered in Dupuytren’s Surgery: A Cadaveric Study. Dupuytren’s Disease and Related Hyperproliferative Disorders. 2012. DOI: 10.1007/978-3-642-22697-7_33

[6] Vascularization of the Median Nerve in the Distal Forearm and its Clinical Significance. The Journal of Hand Surgery. 2009. DOI: 10.1016/s0363-5023(09)60086-1

[7] The Relationship of the Superficial Radial Nerve and Its Branch to the Thumb to the First Extensor Compartment. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.12.004

[8] Chapter 63 Peripheral Nervous System. 2019.

[9] Vascular Insufficiency of the Upper Extremity. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.06.011

[10] Neurovascular injury from supracondylar fractures in children: a 10-year experience of 762 cases. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231201925

[11] Structure and function of the intraneural microvessels as related to trauma, edema formation, and nerve function. The Journal of Bone & Joint Surgery. 1975. DOI: 10.2106/00004623-197557070-00011

[12] Ulnar Nerve Anatomy. Hand Clinics. 2007. DOI: 10.1016/j.hcl.2007.05.001

[13] Peripheral Nerve Injuries: Advancing the Field Through Research, Collaboration, and Education. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.126

[14] The Berrettini palmar neural communicating branch: a study of 27 cadaveric specimens and determination of a high-risk surgical zone. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221095401

[15] A Quantitative Study of the Vascular Beds of the Hand. The Journal of Bone & Joint Surgery. 1961. DOI: 10.2106/00004623-196143080-00010

[18] Gunshot-Related Upper Extremity Nerve Injuries at a Level 1 Trauma Center. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.03.020

[19] Median Nerve Injury and Repair. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.01.025

[20] The Lateral Dorsal Cutaneous Branch of the Sural Nerve. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512448320

[21] Limitations of Conduits in Peripheral Nerve Repairs. HAND. 2009. DOI: 10.1007/s11552-008-9158-3

[22] Arterial Perfusion of the Proximal Phalanx Revisited: New Insights Based on Micro-Computed Tomography. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2022.09.014

[23] Ischemic Nerves are more Susceptible to Mechanical Injury. The Journal of Hand Surgery. 2009. DOI: 10.1016/s0363-5023(09)60085-x

[24] A Rare Anatomical Variant Dual Radial Digital Nerves in the Right Ring Finger: Consideration in Hand Dissection. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2025.100906

[26] Anatomical Characterization of the Motor Branch to the Fourth Lumbrical: A Cadaver Study. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.11.023

[27] Chapter 23 Anatomy of the Hand and Wrist. 2019.

[28] The distance from the peroneal tendons sheath to the sural nerve at the posterior tip of the fibula decreases from proximal to distal. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05438-x

[29] Risk Factors for a False-Negative Examination in Complete Upper Extremity Nerve Lacerations. HAND. 2019. DOI: 10.1177/1558944719866865

[30] The sensory function of the uninjured nerve in patients after median and ulnar nerve injury. Journal of Hand Therapy. 2017. DOI: 10.1016/j.jht.2016.10.006

[32] Palmar Type of Median Artery as a Source of Superficial Palmar Arch: A Cadaveric Study with its Clinical Significance. HAND. 2009. DOI: 10.1007/s11552-009-9197-4

[33] ARTERIAL VASCULARIZATION OF THE SOFT TISSUES OF THE HAND. The Journal of Bone & Joint Surgery. 1954. DOI: 10.2106/00004623-195436060-00012

[34] More Than Epineurium Deep: Characterizing Peripheral Nerve Damage Using High-Resolution Micro-Computed Tomography for Simulated Peripheral Nerve Lacerations. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100833

[37] The Concomitant Presence of Two Anomalous Muscles in the Forearm. HAND. 2007. DOI: 10.1007/s11552-007-9033-7

[38] Anatomical Characterization and Topographic Mapping of the Distal Ulnar Nerve and Its Peripheral Branches: A Cadaveric Analysis. HAND. 2024. DOI: 10.1177/15589447241306151

[39] Innervation of the Proximal Interphalangeal Joint: An Anatomical Study. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.07.014

[40] 9. Hand Surgery. 2013.

[41] Innervation Patterns of Thumb Trapeziometacarpal Joint Ligaments. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.12.038

[42] Vascular anomalies of the upper limb. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418808130

[47] Chapter 38 Acute and Chronic Vascular Disorders of the Hand and Wrist. 2019.

[48] The neurovascular anatomy of the teres major muscle. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.07.001

[50] Assessment of Conduit-Assisted Primary Nerve Repair Strength With Varying Suture Size, Number, and Location. HAND. 2018. DOI: 10.1177/1558944718769382

[52] Compression of the Medial Half of the Deep Branch of the Ulnar Nerve by an Anomalous Origin of the Flexor Digiti Minimi. A Case Report. The Journal of Bone & Joint Surgery*. 1996. DOI: 10.2106/00004623-199603000-00015

[55] Fingertip replantation at the eponychial level with venous anastomosis: an anatomic study and clinical application. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413490653

[56] Effect of different cuff widths on the motor nerve conduction of the median nerve: an experimental study. Journal of Orthopaedic Surgery and Research. 2008. DOI: 10.1186/1749-799x-3-1

[57] Overcoming Short Gaps in Peripheral Nerve Repair: Conduits and Human Acellular Nerve Allograft. HAND. 2014. DOI: 10.1007/s11552-014-9601-6

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a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.