266 SURGICAL APPLIED ANATOMY. [Chap. xv. 



impressions is the dorsum of the hand. It may be 

 said that the tips of the fingers are about thirty times 

 more acute to the sense of touch than is the skin of 

 the middle of the fore-arm, which is among the least 

 sensitive portions of the integument as regards tactile 

 influences. 



The subcutaneous tissue of the front of the hand, 

 and especially of the palm, is scanty and dense, and 

 somewhat resembles the subcutaneous tissue of the 

 scalp in that the skin is closely adherent to it, and the 

 fat it contains is arranged in minute lobules lodged 

 in lacunae. The subcutaneous tissue on the dorsum 

 is, on the other hand, lax, and has but a frail 

 association with the skin. Thus it follows that 

 subcutaneous extravasations of blood are practically 

 impossible in the palm, and on the anterior aspect 

 of the fingers, while they may be very extensive on 

 the dorsum. In like manner oedema of the extremity 

 is conspicuously marked upon the dorsal surface, while 

 the palm remains comparatively free even in severe 

 cases. Surface inflammations also of the dorsum are 

 attended with considerable swelling, while those of 

 the front of the hand show no such feature. At the 

 same time the adhesion of the palmar integument to 

 the deeper parts is so close that surface wounds do not 

 gape, and are in a position to encourage ready healing. 

 The denseness of the integuments of the palm renders 

 inflammation of the part extremely painful, owing 

 to the tension that is so readily produced, whereas 

 inflammation in the lax tissues on the dorsum may 

 reach some magnitude without causing great pain. 

 The palm of the hand is well adapted to meet the 

 effects of pressure and friction. The cuticle is thick, 

 the skin is adherent, and immediately beneath it lies 

 the dense palmar fascia. This fascia efficiently 

 protects the palmar nerves and the main vessels, while 

 it must be noted that the front of the hand, and 



