Upper limb arterial pattern: clinical correlation and embryological perspective / Padrão arterial dos membros superiores: correlação clínica com perspectiva embriológica

Abstract Background Variations in the upper limb arterial pattern are commonplace and necessitate complete familiarity for successful surgical and interventional procedures. Variance in the vascular tree may involve any part of the axis artery of the upper limb, including the axillary artery and brachial artery or its branches, in the form of radial and ulnar arteries, which eventually supply the hand via anastomosing arches. Objectives To study the peculiarities of the arterial pattern of the upper limb and to correlate them with embryological development. Methods The entire arterial branching of forty-two upper limbs of formalin fixed adult human cadavers was examined during routine dissection for educational purposes, conducted over a 3-year period in the Department of Anatomy, Lady Hardinge Medical College, New Delhi. Results The study found: 1) One case in which a common trunk arose from the third part of the axillary artery, which immediately splayed into four branches (2.4%); 2) High division of the brachial artery into ulnar and radial arteries, in 3 cases (7.1%); 3) Pentafurcation of the brachial artery into ulnar, interosseus, radial, and radial recurrent arteries and a muscular twig to the brachioradialis in 1/42 cases (2.4%); 4) Incomplete Superficial Palmar arch in 3/42 cases (7.1%); and 5) Presence of a median artery in 2/42 case(4.8%) Conclusions This study observed and described the varied arterial patterns of the upper limb and identified the various anomalous patterns, supplementing the surgeon's armamentarium in various surgical procedures, thereby helping to prevent complications or failures of reconstructive surgeries, bypass angiography, and many similar procedures.

Resumo Contexto As variações no padrão arterial dos membros superiores são comuns e, assim, necessitam de total familiaridade para que os procedimentos cirúrgicos e de intervenção sejam bem-sucedidos. A variância na árvore vascular pode envolver qualquer parte da artéria axial dos membros superiores, incluindo a artéria axilar, a artéria braquial ou os seus ramos, na forma das artérias radial e ulnar, as quais, em algum momento, suprem as mãos através dos arcos anastomosados. Objetivos Avaliar as peculiaridades do padrão arterial dos membros superiores e correlacioná-las ao desenvolvimento embriológico. Métodos Foram examinados os ramos arteriais completos de 42 membros superiores de cadáveres adultos conservados em formalina, os quais eram rotineiramente dissecados para fins educacionais durante 3 anos no Departamento de Anatomia Lady Hardinge Medical College, Nova Delhi. Resultados O estudo apresentou cinco desfechos. 1. Foi constatado um caso em que um tronco comum surgiu da terceira parte da artéria axilar que imediatamente se disseminou em quatro ramos (2,4%). 2. Houve divisão maior da artéria braquial em artérias ulnar e radial em três casos (7,1%). 3. Em um caso, ocorreu pentafurcação da artéria braquial em ulnar, interóssea, radial, radial recorrente e de um galho muscular em braquiorradial (2,4%). 4. Foi constatado arco palmar superficial incompleto em três dos 42 casos (7,1%). 5. Foi observada a presença da artéria mediana em 2 dos 42 casos (4,8%). Conclusões Este estudo compreende o padrão arterial do membro superior e identifica os diversos padrões anômalos para agregar ao arsenal terapêutico de cirurgiões para diversos procedimentos cirúrgicos, com o objetivo de combater quaisquer complicações ou falhas de cirurgias reconstrutivas, de angiografias de cirurgias de revascularização e muitas outras.

Morphological and Morphometrical Analysis of The Vermian Fossa In Dry Adult Skulls of Western Uttar Pradesh Population: An Osteological Study.

Aim: The internal occipital crest (IOC) occasionally diverges at the lower end around the foramen magnum, giving rise to roughly triangular shaped vermian fossa. Variations occur in the vermian fossa in the form of shape and size. There is paucity of such study in the available literature, hence the present study was undertaken to evaluate the incidence, morphology and morphometry of the VF in the adult population of Western Uttar Pradesh. Material and method: Adult human 30 cranial bases (vault removed) and 25 occipital bones of both the sexes, which were obtained from the osteology section of department of anatomy in LLRM Medical College, Meerut (UP), formed the basis for this study. The fossa were macroscopically examined and classified into Type1 (triangular shape), Type 2 (quadrangular shape), and Type 3or atypical type (fossa shape was other than the above said). Result: Out of the 55 specimens the VF was observed in 40(72.7%) specimens, and was found absent in the remaining 15(27.2%) specimens. The VF was triangular shaped in 29(72.5%) specimens and quadrangular in 4(10.0%) specimens. In 7(17.5%) specimens it was having unusual morphology and considered as atypical. Among the atypical types, two specimens were having deep fossa, one was having partitioned VF, and four of them had widened VF. The average length and width of the fossa were 14.2 mm and 12.1 mm respectively. Conclusion: The incidence is higher in our study as compared to the previous studies and it might be because of racial variations. Accurate knowledge of the variability of the human morphology and morphometry improves the diagnosis and therapeutic performance and also helpful in the study of the diseases that cause alterations of size and morphology of inferior vermis of cerebellum and clinician who operates intracranially or interprets radiological imaging. Hence this study is enlightening for the neuroanatomists and morphologists.