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A spectrum. Clin Orthop Relat Res 1984; 36–42. [22] Ruch DS, Marr A, Holden M, et al. Innervation density of the base of the palm. J Hand Surg [Am] 1999;24:392–7. [23] Watchmaker GP, Weber D, Mackinnon SE. Avoidance of transection of the palmar cutaneous branch of the median nerve in carpal tunnel release. J Hand Surg [Am] 1996;21:644–50. [24] Martin CH, Seiler JG 3rd, Lesesne JS. The cutaneous innervation of the palm: an anatomic study of the ulnar and median nerves. J Hand Surg [Am] 1996;21:634–8.

The surgery performed. The authors do not particularly recommend curvilinear or zigzag incisions, because they do not appreciably improve either the exposure or the cosmesis of the wound scar. Furthermore, there is a risk of flap ischemia or necrosis with curvilinear or zigzag incisions, particularly in patients who have poor skin vascularity [8,9]. The other important consideration of this incision is that it will most likely avoid the branches of the superficial radial nerve and the dorsal cutaneous branch of the ulnar nerve [10–14].

The most common source was bronchial carcinoma, and the terminal phalanges were the typical site of metastatic disease. Metastatic lesions were less frequently seen in the other phalanges and the metacarpals; one case occurred in the carpus. The few reports of metastases to the carpus are typically from bronchial carcinoma, although metastases from other tumors such as prostate, breast, larynx, stomach, and bone sarcoma have been described [8,68–79]. Ioia and colleagues [77] reported a case of metastatic bronchial carcinoma to the scaphoid presenting with wrist pain, swelling, and tenderness.

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