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@#Introduction: Single-portal endoscopic carpal tunnel release using modified Agee technique is widely used in Vietnam. Yet information on the anatomy of the target space of Vietnamese people regarding this technique is scarce. We aimed to characterise the anatomical landmarks and variations of the carpal tunnel to propose a safer surgery. Materials and methods: All twenty hands of ten fresh frozen, unembalmed cadavers of Vietnamese adults were included. Dissection was performed after the vertical line, Kaplan’s cardinal line and the distal wrist crease were drawn. The transverse carpal ligament (TCL), ulnar neurovascular bundle and superficial palmar arch were exposed. Measurements were made using Mitutoyo calliper. The variants of the median nerve and in the course of the thenar motor branch were recorded. Results: The median distances from the TCL distal margin to the distal wrist crease and superficial palmar arch were 31.2mm and 12.7mm, respectively. The ulnar neurovascular bundle was located 5.7mm and 4.4mm ulnar to the vertical line at the level of the TCL proximal margin and at the level of the TCL distal margin, respectively. The thenar motor branch of the median nerve was extra-ligamentous in 19 hands and preligamentous in 1 hand. Conclusion: If endoscopic portal is made along the distal wrist crease, blade assembly should not be inserted beyond the 35mm mark on its scale. Instruments should be aimed toward the radial border of the patient’s ring finger. Surgeons should be aware of the preligamentous course of the thenar motor branch although this variant type is rare.
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Objective:The surgical method and clinical efficacy was studied on the anterior lateral malleolar venous network grafting in repair of the defects of superficial palmar arch.Methods:From February 2015 to July 2021, 8 cases (6 males and 2 females; aged 32-44 years old, mean age at 39 years old) were treated in the Department of Hand Surgery of Yantaishan Hospital. Anterior lateral malleolar venous network was grafted to repair the defects of superficial palmar arch of the patients. The patients had different degrees of tendon damage, and injuries of nerve, deep palmar arch, common palmar digital artery or proper palmar digital artery. The length of the vessel defect was 6.0-10.0 cm. Blood supply insufficiency occurred in 1st-5th digits in 1 case, 2nd-4th fingers in 5 cases, and 2nd-5th fingers in 2 cases. The anterior lateral malleolar venous network was transferred to repair 3 broken ends of vessels in 5 cases, 4 broken ends in 1 case and 5 broken ends in 2 cases. The wound of hand was sutured directly in 2 cases. The emergency surgical repair of the wound of hand by transfer of ALTPF was performed in 2 patients, and elective ALTPF transfer in 3 cases. Forearm dorsi-ulnar flap transfer was performed in 1 case. The follow-up reviews were carried out via the outpatient clinic visit, telephone, WeChat interviews or home visits. The blood supply of the distal digit, skin sensation, TPD, the range of motion of the phalangeal joints were observed.Results:The results showed that all the digits and the grafted flaps survived. The follow-up was carried out for 10-53 months, with an average of 17.9 months. The functions of digit extension and flexion, finger opposition and thumb opposition were restored in 5 cases, and the patients returned back to former jobs. The finger flexion and thumb opposition were limited in 3 cases, and these cases participated in light physical work. The proprioception of the digits were recovered, and the TPD was 5-7 mm. Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association and rated as excellent in 5 cases and good in 3 cases. The donor sites of the foot showed a linear scar. There was no effect on the function and the shape of the donor site.Conclusion:The anterior lateral malleolar venous network grafting is an ideal method in repair of the defects of superficial palmar arch.
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RESUMEN: El objetivo de este trabajo consiste en el análisis de la posición del arco palmar superficial en la palma de la mano, con identificación del origen, forma de disposición, anastomosis presentes y terminación del mismo, proporcionando la experiencia propia y comparándola con los referentes del área, sin llevar adelante una comparación de clasificaciones, sino por el contrario, buscando analizar la información desde un punto de vista clínico-quirúrgico, demostrando la importancia del conocimiento de la anatomía real del arco palmar superficial al momento de abordar la anatomía vascular de la mano en todo tipo de situaciones patológicas.
SUMMARY: The objective of this work consists in the analysis of the position of the superficial palmar arch in the palm of the hand, with identification of the origin, form of disposition, present anastomosis and termination of the same, providing the own experience and comparing it with the referents of the area, without carrying out a comparison of classifications, but on the contrary, seeking to analyze the information from a clinical-surgical point of view, demonstrating the importance of knowledge of the real anatomy of the superficial palmar arch when addressing the vascular anatomy of the hand in all kinds of pathological situations.
Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Ulnar Artery/anatomy & histology , Radial Artery/anatomy & histology , Anatomic Variation , Hand/blood supply , CadaverABSTRACT
El arco palmar superficial (APS) resulta de la unión de la arteria ulnar y la rama palmar superficial de la arteria radial. Por su convexidad nacen las arterias digitales comunes. Esta descripción es la única que distintos autores han tomado como válida, por lo que se espera encontrarla durante la disección con mayor frecuencia. Esto no ha sido verificado en nuestra experiencia. Nos proponemos llevar a cabo una revisión de la descripción del APS poniéndolo en contraposición con las disecciones realizadas. Se disecaron y analizaron 61 manos cadavéricas. Estudio del arco palmar superficial: Variante clásica del APS: 23 casos (37,7 %). Variante no clásica del APS: 15 casos (24,6 %). Tipo A: 13 casos (86,7 %). Anastomosis entre arterias ulnar y metacarpiana dorsal del primer espacio. Tipo B: 2 casos (13,3 %). Anastomosis entre arterias ulnar y satélite del nervio mediano. Ausencia del arco: 23 casos (37,7 %) Tipo A: 19 casos (82,6 %). La arteria ulnar es la única estructura en el plano del APS. Tipo B: 3 casos (13 %). La arteria ulnar y la rama palmar superficial de la arteria radial están en el plano del APS sin anastomosarse entre sí. Tipo C: 1 caso (4,4 %). La arteria ulnar y la satélite del nervio mediano están en el plano del APS sin anastomosarse. Estudio de la quinta arteria digital palmar común: La quinta arteria digital palmar común se originó de las distintas variantes en 41 casos (67,2 %). Recomendamos al momento de la disección considerar que: la variante clásica no es la más frecuente de hallar; la ausencia del arco se verifica en el mismo porcentaje que la variante clásica; incluso cuando se comprueba la presencia del APS, el porcentaje de la variante no clásica es contundente; la quinta arteria digital palmar común es una rama colateral constante del APS.
The superficial palmar arch (SPA) is formed by the union of the ulnar artery and the superficial palmar branch of the radial artery. From its convexity four branches emerge, known as the common palmar digital arteries. We propose to carry out a review of the description of the SPA in contrast to the dissections carried out. Sixty-one hands were dissected and studied. Analysis of the SPA: Classic variant of the SPA: 23 cases (37.7 %). Nonclassic variant of the SPA: 15 cases (24.6 %). Type A: 13 cases (86.7 %). Anastomosis between the ulnar artery and the first dorsal metacarpal artery. Type B: 2 cases (13.3 %). Anastomosis between the ulnar artery and the satellite artery of the median nerve. Absence of the arch: 23 cases (37.7 %) Type A: 19 cases (82.6 %). The ulnar artery is the only one present in the plane of the SPA. Type B: 3 cases (13 %). The ulnar artery and the superficial palmar branch of the radial artery are in the plane of the superficial palmar arch, there is no anastomosis between them. Type C: 1 case (4.4 %). The ulnar artery and the satellite artery for the median nerve are in the plane of the SPA, there is no anastomosis between them. Analysis of the fifth common palmar digital artery: The fifth common palmar digital artery originates from the different variants in 41 cases (67.2 %). Based on the results, we recommend at the time of dissecting consider that: The classic variant is not the most frequent to find. The absence of the arch is verified in the same percentage rate as the classic variant. Even when the SPA is present, the percentage rate of the non-classic variant is significant. The fifth common palmar digital artery is a constant collateral branch of the superficial palmar arch.
Subject(s)
Humans , Male , Female , Adult , Ulnar Artery/anatomy & histology , Hand/blood supply , Radial Artery/anatomy & histology , Anatomic VariationABSTRACT
Background: Knowledge regarding the course and termination of the radial artery before harvesting it for coronaryartery bypass graft surgery (CABGS) is important. The brachial artery terminates at the neck of radius into radialand ulnar arteries.Purpose of the study: To know the various patterns of anomalous division ofthe radial artery.Methods: The study included 50 upper limb specimens from the Department of Anatomy, Sree Narayana Instituteof Medical Sciences, Ernakulam. The specimens were fixed with 10% formalin solution and the radial artery wasexposed from its origin till termination and observations were noted down.Results: The present study revealed that, radial artery usually was arising from brachial artery at the level ofneck of radius. The variants observed included high bifurcation of brachial artery, division of radial artery intopalmar and dorsal branches in the forearm and anomalous course of radial artery in the region of anatomicalsnuff box.Conclusion: The present study has revealed the anomalous division and course of radial artery around the wristand anatomical snuff box and the knowledge of such anomalous course is important for diagnostic, interventionaland surgical procedures.
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Background: The functional importance of hand is revealed by its rich vascularity contributed by superficial anddeep palmar arches (SPA and DPA). The efficiency of collateral circulation in hand by SPA and DPA is essential incertain peripheral vascular diseases like Raynaud’s disease and in harvesting radial artery for coronary arterybypass graft (CABG). Knowledge of variations in the arterial supply of hand is important while performingmicrosurgical procedures like arterial repair, vascular graft and flap application.Objective: To study the morphology of the Superficial Palmar Arch and variation in its formation.Materials and methods: We have dissected 30 cadaveric hands at Department of Anatomy of Medical Collegeand Hospital, Kolkata.Result and conclusion: Out of 30 specimens, variations were observed in 14 specimens. Out of 14 specimens in 11specimens SPA was formed alone by Ulnar Artery, in two specimens SPA was incomplete formed by superficialpalmar branches of Ulnar and Radial Artery, in one specimen there was presence of Persistent Median Arterywith incomplete SPA. All the variations found were present unilaterally. In rest 16 specimens SPA was completeclassical radio-ulnar type.
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Objective@#To explore the clinical effects of dorsal perforator fascia pedicle flap of the deep palmar arch in the repair of skin and soft tissue defects of finger web area.@*Methods@#Eleven patients (7 males and 4 females, aged from 18 to 73 years) with soft tissue defects of finger web area in distal dorsal side were admitted to Xinhua Hospital (Chongming) of Shanghai Jiao Tong University School of Medicine from October 2010 to September 2018. The sizes of skin and soft tissue defects ranged from 2.5 cm×1.5 cm to 6.0 cm×2.5 cm. According to the origin, course, branches, and distribution of the dorsal perforator of deep palmar arch, and the anatomical characteristics with vascular network of dorsal carpal and dorsal metacarpal, dorsal perforator fascia pedicle flaps of the deep palmar arch from the back of the injured hands were designed and transferred to repair the wounds of finger web area in distal dorsal side. The sizes of the flaps of patients ranged from 3.5 cm×2.0 cm to 6.5 cm×3.0 cm. The donor sites were sutured directly or covered with free forearm full-thickness skin graft. The clinical effects and swelling degree of flaps in early and late stages were evaluated during the follow-up of 3 to 36 months post surgery.@*Results@#All the flaps survived in 11 patients, the incisions in donor and recipient sites were healed. During the follow-up of 3 to 36 months post surgery, the survival of flaps was good, and the appearance, color, and elasticity were close to normal skin, with two-point discrimination distance of 7 to 10 mm and sensory function recovery of grade S3. The wounds in donor site had small scar without infection. The efficacy was evaluated as satisfactory in 8 patients, general in 3 patients, and dissatisfactory in no patient. Flap swelling rating in early stage was 1st degree in 7 patients, 2nd degree in 2 patients, and 3rd degree in 2 patients. Flap swelling rating in late stage was 1st degree in 8 patients, 2nd degree in 2 patients, and 3rd degree in 1 patient. The extension and flexion of the metacarpal and interphalangeal joints were basically normal and the patients were satisfied with the outcomes.@*Conclusions@#Based on the dorsal perforator of deep palmar arch, dorsal perforator fascia pedicle flap of the deep palmar arch is reliable to transfer to repair skin and soft tissue defects of finger web area in distal dorsal side, which is worthy of promotion in clinic.
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Background: Superficial Palmar Arch (SPA) is an arterial arcade usually formed by the continuation of ulnarartery and the superficial branch of radial artery. Variations can occur in the vessels contributing to the formationof SPA. Knowledge of such variations will be very much helpful to microvascular surgeons, plastic surgeons andorthopaedicians to bring a better outcome in their surgical procedures. Also, it will be useful to the cardiovascularsurgeons to carryout radial artery harvesting procedures for the purpose of Coronary Artery Bypass Grafting. Themain objective is to study the different patterns of formation of the superficial palmar arch with an emphasis ontheir clinical importance.Materials and methods: This study was done in 40 upper limb specimens from 20 embalmed human adultcadavers at the Institute of Anatomy, Madras Medical College, Chennai. In every upper limb specimen, the palmwas dissected as per the steps described in the Cunningham’s Manual of Practical Anatomy. The SuperficialPalmar Arch was exposed and the vessels taking part in its formation were studied. Variations in the formationof Superficial Palmar Arch were noted and analysed.Results: Out of 40 specimens, the Superficial Palmar arch was found to be complete in 29 specimens (72.5%) andincomplete in 11 specimens (27.5%).Conclusion: Information about the different patterns in the formation of the Superficial Palmar Arch will beextremely useful for hand surgeons, microvascular surgeons, plastic surgeons and orthopaedicians to bring outa successful and beneficial postoperative outcome. Awareness about these variations will also help in appropriateinterpretation of investigations prior to radial artery harvesting for the purpose of Coronary Artery BypassGrafting.
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Background: Superficial palmar arch (SPA) is an important arterial anastomotic arcade which is the dominant vascular supply to the majority of the palmar muscles. Objectives: Keeping the importance of these variations in mind this study was designed to find out the pattern of superficial palmar arterial arches. Materials and Methods: A total of 40 adults upper limbs of unknown sex were observed for the variations in the pattern of superficial palmar arches on right and left side and were compared with the previous data. Results: A complete superficial palmar arch was encountered in 72.5% (n=29/40) of specimens and an incomplete SPA was observed in 27.5% (n=11/40) of specimens. Conclusion: Knowledge of the variations in the arterial supply of hand is essential in advent of microvascular surgery for revascularisation, replantation and composite tissue transfers
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Background: Superficial palmar arch (SPA) is an important arterial anastomotic arcade which is the dominant vascular supply to the majority of the palmar muscles. Objectives: Keeping the importance of these variations in mind this study was designed to find out the pattern of superficial palmar arterial arches. Materials and Methods: A total of 40 adults upper limbs of unknown sex were observed for the variations in the pattern of superficial palmar arches on right and left side and were compared with the previous data. Results: A complete superficial palmar arch was encountered in 72.5% (n=29/40) of specimens and an incomplete SPA was observed in 27.5% (n=11/40) of specimens. Conclusion: Knowledge of the variations in the arterial supply of hand is essential in advent of microvascular surgery for revascularisation, replantation and composite tissue transfers
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Variations of the arteries of the upper limb are an often encountered phenomenon and have been widely described in case reports and studies over the years. The superficial palmar arch (SPA) is the main source of blood supply to the palm and digits. The classical SPA is formed by an anastomosis between the superficial branches of the radial and ulnar artery, although a number of other variations have been described. Herein, we present a peculiar formation of the SPA between the superficial branch of the ulnar artery and a communicating branch from the princeps pollicis artery. We also noted an unusual origin of the radialis indicis artery from the SPA. According to the classifications of SPA variations, the observed SPA was type II or a dominant ulnar subtype of the non-arch type. The knowledge of arterial variations in the hand is important for the successful conduction of surgical and diagnostic manipulations in the hand and is therefore of interest to anatomists and clinicians.
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Objective To evaluate the value of the color Doppler ultrasonography in assessing the changes of the superficial palmar arch arteries and the proper palmar digital arteries in patients with Raynaud's phenomenon.Methods The color Doppler ultrasonography was used to check the left superficial palmar arch arteries and the left middle finger proper palmar digital arteries in 42 patients with Raynaud's phenomenon (case group).The blood vessel flow,blood flow filling and hemodynamic parameters were recorded.The hemodynamic parameters include peak systolic velocity (PSV),end diastolic velocity (EDV),resistance index (RI) and pulsatility index (PI).The control group was 35 healthy adults who received physical examination.The above parameters were measured,and the difference of the parameters between the case group and the control group were compared.Results The blood flow signal dispayed rate of the left superficial palmar arch arteries of case group was good,almost 100％ (42/42);the blood flow of the middle finger proper palmar digital arteries was poor,the blood vessel was thinner and even occluded,the blood flow signal displayed rate was 92.86％ (39/42).Compared with the control group,the PSV and EDV of the left middle finger proper palmar digital arteries decreased,the EDV of the superficial palmar arch arteries decreased also,but the RI and PI increased in case group (all P＜0.05),The PSV of the left superficial palmar arch arteries of the case group was lower than that of the control group,and there was no significant difference between both groups (P＞0.05).Conclusion The color Doppler ultrasonography can evaluate the hemodynamic changes of the proper palmar digital arteries and the superficial palmar arch arteries in patients with Raynaud's phenomenon,and provide effective evidence for the diagnosis and treatment of Raynaud's phenomenon.
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Objective@#To investigate the morphological characters of the dorsal perforators originated from the deep palmar arch, so as to provide anatomic basis for V-Y advanced perforator flap.@*Methods@#The following contents were investigated in 30 adult hand specimens perfused with red latex under surgical magnifier: ①The origin, courses, branches and distribution of the dorsal perforators originatedd from the deep palmar arch. ②The characters of anastomosis among the dorsal perforators, the dorsal carpal and metacarpal arteries. Mimic operation was performed on another fresh specimens perfused with red latex.@*Results@#There were three perforators originated from the deep palmar arch, which passed through the 2nd-4th dorsal interossei and then divided into an ascending branch and a descending branch at the dorsum of hand. Then the ascending branch anastomosed with the dorsal carpal artery, and the descending branch stretched to the 2nd-4th dorsal metacarpal arteries. The originating outer diameters of the 1st-3rd perforators were (1.1±0.2) mm, (0.9±0.3) mm and (0.7±0.1) mm respectively, and the length of the stems were (1.1±0.3) cm, (1.0±0.2)cm and (0.9±0.1) cm respectively.@*Conclusions@#The V-Y advanced perforator flap with the dorsal perforator of the deep palmar arch as its vascular pedicle could be used to repair the dorsal carpal or dorsal metacarpal soft tissue defects.
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La irrigación de la palma de la mano es proporcionada por arcos arteriales (superficial y profundo) que están conformados más frecuentemente por las arterias ulnar y radial estableciendo un patrón descrita como clásico. Se describen variaciones anatómicas en la conformación de ambos arcos, más frecuentemente en el arco palmar superficial; pudiendo ser los mismos completos o incompletos. Es objetivode este trabajo, la descripción anatómica de los arcos palmares, de sus diferentes patrones y variaciones de conformación, y sus implicancias clínico-quirúrgicas. Se llevó a cabo un estudio descriptivo, observacional y morfométrico de las arterias que participan en la formación de los arcos palmares; se utilizaron 100 preparaciones cadavéricas fijadas en solución de formol, de la Tercera Cátedra de Anatomía - Facultad de Medicina- Universidad de Buenos Aires. Se realizó además un análisis retrospectivo de casos con lesiones de la/sarteria/s principal/es que conforman los arcos palmares, en el Servicio de Emergencias del Hospital de Morón, entre 2015-2016. La arteria radial conforma el arco arterial profundo con la arteria cubito palmar más frecuentemente en el 100 % de los casos. El arco arterial superficial es el más variable. Fue completo en el 56 % y la presentación más frecuente (83 %) es aquella que se conforma por la anastomosis de la arteria ulnar y la arteria radiopalmar. El resto de las anastomosis son: entre arteria ulnar y arteria mediana (9 %),entre rama profunda de arteria radial y arteria ulnar (5 %); triple anastomosis entre arteria ulnar, arteria mediana y arteria radiopalmar (2 %), y anastomosis entre la arteria mediana y la arteria radiopalmar, sinparticipación de la arteria ulnar (1 %). El resto de la muestra (44 %) se lo puede denominar como incompleto. Los subtipos B1a y B1b fueron los más encontrados. Se describen dos casos clínicos, uno con sección completa de la arteria radial a nivel de la muñeca y el otro con sección completa de arteria ulnar con compromiso del nervio ulnar. Resulta esencial un correcto conocimiento de los arcos palmares para un adecuado abordaje quirúrgico de la mano. La importancia de la presencia o ausencia, así como de las distintas variaciones de los arcos arteriales palmares radica en su aplicación clínica quirúrgica como punto departida en el tratamiento del trauma como de otras patologías en las que existe compromiso de estos vasos.
The irrigation of the palm is provided by arterial arches (shallow and deep) that are made more frequently by the ulnar or radial arteries described as setting a classic pattern. Anatomical variations are described in shaping both arches, most often in the superficial palmar arch; may be the same complete or incomplete. The objective of this work is the anatomical description of the palmar arches, their different patterns and variations in conformation, and their clinical and surgical implications. A descriptive, observational and morphometric study of the arteries involved in the formation of the palmar arches was done in the Faculty of Medicine, University of Buenos Aires. One hundred 1(00) cadaveric preparations fixed in formalin solution, of the Third Chair of Anatomy were used. A retrospective analysis of cases with lesions / s artery /main / s that make the palmar arches in the Emergency Hospital of Moron, between 2015-2016 s was alsocarried out. Most frequently the radial artery forms the deep palmar arch with the deep palmar branch ofthe ulnar artery. Superficial palmar arch is the most variable. It was complete in 56 % and the most common presentation (83 %) is one that is formed by the anastomosis of the ulnar artery and the superficial palmar branch of the radial artery. The rest of the anastomosis are between ulnar artery and median artery(9%), between deep branch of radial artery and ulnar artery (5 %); triple anastomosis between ulnar artery,median artery and superficial palmar branch of the radial artery (2 %), and anastomosis between the median artery and superficial palmar branch of the radial artery without participation of the ulnar artery (1%). The rest of the sample (44 %) can be termed as incomplete. The B1a and B1b subtypes were the mostfound. Two cases, one entire section of the radial artery at the wrist and the other with complete section ofulnar artery with involvement of the ulnar nerve are described. It is essential to a proper understanding ofthe palmar arches for a suitable surgical approach to hand. The importance of the presence or absence, aswell as different variations of palmar arterial arch lies in its clinical application as surgical starting point in the treatment of trauma and other diseases in which there is engagement of arteries.
Subject(s)
Humans , Ulnar Artery/anatomy & histology , Radial Artery/anatomy & histology , Hand/blood supply , Hand Injuries/pathology , Cadaver , Ulnar Artery/injuries , Radial Artery/injuries , Anatomic VariationABSTRACT
Introducción: La irrigación palmar ha sido investigada en diferentes grupos poblacionales mediante la disección anatómica directa. Sin embargo, no existe una clasificación estandarizada de arcos palmares superficiales, lo cual conduce a que diferentes autores diseñen clasificaciones propias. Objetivo: Determinar los diferentes patrones del arco palmar superficial y la relevancia tanto clínica como quirúrgica de las diversas variantes anatómicas asociadas a esta estructura. Metodología de búsqueda: Se realizó una búsqueda de literatura en las bases de datos Medline, Ovid, Proquest, Cochrane, SciELO, Lilacs y Hinary, además de textos clásicos de anatomía y cirugía. Se seleccionaron estudios retrospectivos y transversales en especímenes cadavéricos realizados en diferentes grupos poblacionales entre 1987 hasta 2014. Resultados: Se utilizó la clasificación de arco palmar superficial establecida por Lippert y Pabst, que presentó el arco palmar superficial completo como el patrón vascular más común, con una prevalencia del 56,7%, en la que el subtipo más frecuente fue el radio-ulnar clásico con un 64%. La prevalencia del arco palmar superficial incompleto fue de 48,8%, con un subtipo de patrón ulnar reportado en el 24,7% de las muestras evaluadas. Conclusiones: El adecuado conocimiento de los diferentes patrones de la irrigación palmar es esencial para realizar abordajes exitosos en cirugías de mano y para la comprensión de la fisiopatología de enfermedades de carácter laboral como el síndrome de martillo hipotenar. MÉD UIS. 2015;28(3):363-9.
Introduction: The palmar irrigation has been the subject of research in different population groups using direct anatomical dissection. However, there is no standardized classification of superficial palmar arches, which leads the different authors to design own classifications. Objective: to determine the different patterns of superficial palmar arch, and the clinical and surgical revelance of the various anatomical variants associated with this structure. Research methodology: A literature search was performed in data bases Medline, Ovid, Proquest, Cochrane, Scielo, Lilacs and Hinary, besides classical texts of anatomy and surgery. Retrospective and cross-sectional studies were selected in cadaveric specimens made in different population groups between 1987 to 2014. Results: It was used the superficial palmar arch classification established by Lippert and Pabst, that presented the complete superficial palmar arch as the most common vascular pattern, with a prevalence of 56.7%, in which was the most common subtype the classic radio-ulnar (64%). The prevalence of incomplete surperficial palmar arch was 48.8%, with a subtype of ulnar pattern reported in 24.7% of the samples tested. Conclusions: Adequate knowledge of the different patterns of palmar Irrigation is essential for successful approaches in hand surgery, and for understanding the pathophysiology of diseases related to employment as hypothenar hammer syndrome. MÉD UIS. 2015;28(3):363-9.
Subject(s)
Humans , Hand , Arteries , Ulnar Artery , Radial Artery , Anatomic VariationABSTRACT
The functional importance of hand is revealed by its rich vascularity contributed by superficial and deep palmar arches (SPA and DPA).Superficial palmar arch is located superficial to flexor tendons, and deep palmar arch deep to lumbrical muscles. Variations are found more often in SPA than DPA, later being more or less constant. During routine undergraduate dissection, we observed, unilateral incomplete SPA being formed by superficial palmar branches of ulnar and radial artery in the right hand of a male cadaver. These two arteries remained independent without anastomosis forming incomplete arch (SPA).The superficial branch of ulnar artery entered hand superficial to flexor retinaculum and supplied middle, ring and little finger by three branches. The superficial branch of radial artery via its two branches supplied index finger and thumb. Classical SPA formation was seen on left side. The presence of an incomplete SPA as in this case is a potential danger in RA harvesting for CABG.Variations in SPA play a pivotal role in microvascular surgical procedures of hand, RAinterventions and arterial graft applications.
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Background: The median artery is a transitory vessel that represents the arterial axis of the forearm during early embryonic life. When present, it appears mainly as two types: antebrachial and palmar. Context and purpose of the study: In the present study the objective was to investigate the occurrence and fate of palmar type of median artery. The study was conducted on 40 cadaveric upper extremities dissected in the department of Anatomy, Guru Gobind Singh Medical College, Faridkot, India. Results: In the present study, persistent median artery (palmar type) was seen in 2.5% of the limbs dissected. It was originating from the posterior aspect of the ulnar artery approximately 3.2 cm distal to the elbow joint. It pierced the median nerve (traversing from its medial to its lateral aspect) in the proximal third of the forearm. The artery then travelled lateral to the median nerve in rest of the forearm. Subsequently, it accompanied the median nerve into the palm passing deep to the flexor retinaculum. Finally, the artery terminated by completing the superficial palmar arch. In addition to the above described variant blood vessel, we also observed high division of median nerve into its medial and lateral branches. Clinical implications: When median artery is patent and reaches the hand, it forms the only arterial supply to the median nerve and damage to this artery could have serious effects. The aim of our study was to provide additional information about anomalous palmar type of median artery and its clinical implications.
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Superficial palmar arterial arch is an arterial arcade, which is a dominant vascular structure of the palm. It is defined as the anastomoses between the superficial branch of the ulnar artery and the superficial palmar branch of the radial artery. The superficial palmar arch completed by anastomosing with one of the branches of radial artery, i.e. with arteria radialis indicis, arteria princeps pollicis, arteria nervi mediana. The present study reporting a variation of superficial palmar arch which is formed alone by superficial branch of ulnar artery and it is also giving branches to radial side of index finger and to the thumb. Normally the branch to the radial side of index finger receives branch from superficial terminal branch of radial artery and it is known as arteria radiclis indicis. The ARI was given by ulnar artery from the terminal part of radial side along with the princeps pollicis branch. The knowledge of variations of the vascular arches warrants the surgeons while performing surgeries on hands, such as arterial repairs, vascular graft applications.
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After arising from the brachial artery in the cubital fossa the ulnar artery usually passes deep into the superficial flexor muscles of the forearm. In the lower two-thirds, it typically follows a sub-fascial course. In the present case, during a routine undergraduate course dissection of a cadaver, it was found that the ulnar artery arose normally as a terminal branch of the brachial artery in the cubital fossa, followed a sub-fascial course by lying superficial to the flexor muscles then completed the superficial palmar arch in hand. This artery gave only minute muscular branches in the forearm. Moreover, the main branches that usually arise from the ulnar artery were given off by the radial artery. This type of variation is of importance for both the clinicians and surgeons due to its vulnerability to injuries and of academic interest for anatomists.
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Background: The study of superficial palmar arch and its variations has been reported rarely. The purpose of the study is to provide assessment of anatomical variations in the formation of superficial palmar arch in hand. A classic superficial palmar arch is formed by direct communication between the superficial branch of the ulnar artery and superficial branch of radial artery. Materials and Methods: Twenty dissected upper limb specimens, out of which 16 males and 4 females aged between 18 – 75years were obtained from Department of Anatomy, Bangalore Medical College and Research Institute, Bangalore. The vascular pattern of superficial palmar arch was recorded. Results and Discussion: The complete and incomplete formation of the superficial palmar arch was found in 19 and 1 hands respectively. This indicates that the incidences of complete and incomplete formation of superficial palmar arch are 95% and 5% respectively. Conclusion: The findings suggest that the incomplete formation of superficial palmar arch will lead to ischemia or poor nourishment of intrinsic muscles of the hand.