During the surgical fasciectomy for a severe Dupuytren’s contracture of the proximal interphalangeal (PIP) joint, the surgeon must identify and protect the digital neurovascular bundle. The formation of the ‘spiral cord’ pathologically displaces this bundle in which specific direction?

Explanation:
The correct option is c. The spiral cord is a notorious pathological structure in Dupuytren's disease responsible for PIP joint contractures. It forms from the diseased amalgamation of the pretendinous band, spiral band, lateral digital sheet, and Grayson's ligament. As this cord contracts, it literally wraps around the digital neurovascular bundle, pulling the nerve and artery from their normal deep, lateral position into a highly dangerous central and superficial position, lying right beneath the skin crease. An unwary surgeon making a standard skin incision is at extremely high risk of blindly transecting the digital nerve. Reference: McFarlane RM. Patterns of the diseased fascia in the fingers in Dupuytren's contracture. Plast Reconstr Surg.