Teaching Palmar Anatomy: A Comparative Case Study of Conventional Scalpel Dissection With an Innovative Hydro‐dissection Method

Abstract

We present a comparative case study of two dissection methods for teaching palmar anatomy: 1) an innovative hydro‐dissection method using water and brushes, and 2) conventional scalpel dissection. The objective was to compare the visibility of palmar structures for students using the two methods. Conventional dissection methods used to study the palmar aspect of the hand are difficult for students, due to the thickness of the skin firmly bound to the palmar aponeurosis and the drying of tissue layers in the course of dissection. This difficulty complicates students' observation of key structures in the hand, such as nerve innervations and deep fascia. A method of hydro‐dissection we have developed based on descriptions found in an ancient Indian surgical Āyurvedic treatise, the Susruta Saṃhitā, is tested here as an alternative method. The hand dissected using the hydro‐dissection method was soaked for seven days in a six‐liter tank filled with distilled water moving at a constant velocity. Subsequently, the students used special blunt metal brushes designed for this technique, for peeling and scraping the tissue while the hand was submerged. The second hand was dissected using conventional scalpel cutting dissection methods. These two processes are presented with documentation and photographs showing the structures visible over time during the course of both dissection processes. The results were that superficial fascia, the venous network, the lymphatic vessel distribution, the superficial branching of the radial nerve and ulnar nerve were more clearly visible in the hand that had undergone hydro‐dissection. The fascial compartments, short muscles of thumb and little finger, deep and superficial branches of ulnar nerve, deep and superficial palmar arch, and retinaculum were identified by the students more easily in the course of hydro‐dissection, due to the ease of tracing in comparison with the conventional method. The fibrous sheath expansions of both the flexor and extensor expansions could be identified using this method without a high‐level of skill and experience in dissection. Students were also able to make clearer identification of ligaments because they are not cut in the process. Movements of the digits was easier because the tissues were well‐moistened throughout the study. Articular study of the palm with the major and minor joints was also simplified since hydration in hydro‐dissection preserved the capsules and tiny ligaments from the usual damages occurring during blade dissection. In conclusion, hydro‐dissection is an effective blunt dissection method for students studying palmar anatomy and, we suggest, also for plantar anatomy. This method is particularly effective for entry‐level students without a high level of skill in dissection. We are currently working to develop a hydro‐dissection machine to standardize water quality, temperature, pressure, and flow, so that we can test this method on other structures and eventually develop an atlas and manual of hydro‐dissection. This study demonstrates the efficacy of hydro‐dissection for teaching structures in the palmar aspect of the hand.Support or Funding InformationGovernment Ayurveda Medical College ThiruvananthapuramThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.