Study of contributing arteries to superficial palmar arch formation

The superficial palmar arch (SPA) is formed predominantly by the ulnar artery with a contribution from the superficial palmar branch of the radial artery.: To study contributing arteries in superficial palmar arch formation and variations in its formation.: Study comprised of 30 upper limbs from 15 cadavers. Palmar arches in them were dissected following classical incisions and dissection procedures of Cunninghams’ manual.: SPA was formed by superficial branch of ulnar artery only in 13.33% specimens, by superficial branch of both ulnar and radial artery in 70% specimens, by superficial branch of ulnar and persistent median artery in 13.33% specimens and was formed by superficial branches of ulnar and radial arteries with persistent median artery in 3.33% specimens. SPA was complete in 80% and was incomplete in 20% specimens.: The arch formation is highly variable. Knowledge of contribution to the SPA will be helpful to the reconstructive hand surgical procedures such as arterial repairs, vascular graft applications and re-implantations.

Patterns of Arterial Arcades of the Superficial Palmar Arch: A Study In Embalmed Cadaver Palms

Background: The complex and variable pattern of the arterial arcades of the palm form an interesting area of study anatomically and surgically. In the present study arches were classified into complete and incomplete types, the complete type being the most prominent in 88.6% of the palms. Among the complete type, arch formed by ulnar artery alone supplying the thumb and index finger was found in majority of the specimens (50%). The classical or standard superficial palmar arch formed by the superficial palmar branch of radial and ulnar arteries was found in only 28.5%. Different patterns of the arterial arcades of the superficial palmar arch are normally encountered during routine anatomical dissections of the palm which needs to be emphasized and highlighted for a desired surgical out come during microvascular reconstructive surgeries of the palm and during radial artery cannulation. Context: With technological advancements in microsurgical procedures of the hand, fields of anatomical interest like the classification of arterial arcades of the palm, now becomes essential for operating vascular surgeons for a desired surgical outcome Purpose of the study: The present study was taken up to analyze and document varying patterns of the arterial arcades of the superficial palmar arch. Methods and Material: the study was conducted by dissecting 70 randomly obtained formalin fixed cadaver palms. Results: In the present study arches were classified into complete and incomplete types, the complete type being the most prominent in 88.6% of the palms. Among the complete type, arch formed by ulnar artery alone supplying the thumb and index finger was found in majority of the specimens (50%). The classical or standard superficial palmar arch formed by the superficial palmar branch of radial and ulnar arteries was found in only 28.5%. Out of the 70 hands, incomplete arches were found only in 8 hands with an incidence of 11.4%. Conclusion: Knowledge of arterial pattern of the hand is very important to vascular and reconstructive surgeons for effective treatment of injuries of the hand. Such a knowledge of the disposition of the arterial arcades of the palm also enables cardio-vascular surgeons to plan and modify surgical procedures such as radial artery harvesting, cannulation and in preventing the ischemia of hands in such procedures. KEY WORDS: Superficial palmar arch, Arterial arcades, Complete arch, Incomplete arch.

A study of variations in formation of superficial palmar arch in Nepalese cadavers

Introduction: The superficial palmar arch (SPA) is the main source of arterial supply to the palm. It is an arterial arcade formed mainly by the ulnar artery and is completed by the superficial palmar branch of the radial artery. The study was conducted with objective to study the variations in formation of superficial palmar arch in Nepalese cadaveric hands. Methodology: Two horizontal incisions were made, one at the wrist joint and another incision along the root of fingers. A vertical incision was made from the middle of the wrist to the 3rd metacarpo-phalangeal joint. The skin of the palm and the palmar aponeurosis was reflected. The surrounding adipose tissue was removed to view the superficial palmar arch and its branches. Result: In present study, out of 50 specimens of hands, 64% of superficial palmar arch was formed as normal pattern and in 36% cases it was formed by ulnar artery alone. Normal SPA pattern was seen 63% in male and 66.7% in female i.e. higher percentage in female than in male but it was statistically insignificant (P<0.05). SPA-ulnar artery alone pattern was seen 37% in male and 33.3% in female i.e. higher percentage in male than in female, however it was also statistically insignificant (P<0.05). Conclusion: Normal pattern of SPA observed in Sixty-four percent of Nepalese hands and in thirty-six percent cases it was formed by ulnar artery alone. There was no statistically significant difference in SPA pattern distribution between Nepalese male and female.

Traumatic injury of radial and ulnar artery with perfusion of the hand through the median artery: a case report

Case description: A young male patient with a complete section of the ulnar and radial arteries preserved the perfusion of the hand through an anatomical variant, the median artery, identified by angiotomography. Clinical Findings: A wound in the distal third of the left forearm with present pulses and adequate hand coloration. An angiotomography of the upper left limb showed a median artery originating as a continuation of the anterior interosseous artery and ending in the palm of the hand with an incomplete superficial palmar arch. Treatment and Outcomes: Ligation of both radial and ulnar arteries was performed. It was not possible to follow up with the patient. Clinical Relevance: Forming the superficial and deep palmar arches, the irrigation of the hand comes from the ulnar and radial arteries, which can compromise the viability of the limb when injured. The median artery is present in 0.6-21.1% of the population, originates from the anterior interosseous artery (branch of the ulnar), accompanies the median nerve in its path and ends in the palm joining the superficial palmar arch. Diagnostic imaging is a key tool for assessing arterial circulation and characterizing upper limb vascular lesions. Knowledge of the anatomical variations of the arterial supply of the hand, including variability of the superficial palmar arch, is crucial for the safety and success of hand surgeries.

Anatomical variations of the superficial palmar arch and its clinical relevance

Backgorund / Aim. In-depth knowledge of the vascular network of hand is of great importance in modern medicine. The main vessel of hand is the superficial palmar arch. As typically described in anatomical textbooks, it arises as terminal branch of the ulnar artery which then anastomoses with the superficial palmar branch of the radial artery. However, the superficial palmar arch is characterized by remarkable variability, which was the area of interest of many researchers so far. Comprehensive examination of the anatomy of the superficial palmar arch which included two parameters - the formation of the superficial palmar arch and its localization in relation to the topographic landmarks of the hand. Methods. Research was conducted on a total number of 14 cadavers. After careful dissection, variations and distance of the superficial palmar arch from Kaplan?s cardinal line were observed on the right hands. Collected data were then analyzed statistically in SPSS 11.0 using the Mann-Whitney U test, with the accepted level of statistical significance of p < 0.05. Results. According to Coleman and Anson classification, the higher incidence of incomplete type (57.14%) of the superficial palmar arch should be in comparison to complete type (42.86%). In addition to this, a statistically significant difference discovered in distance of the superficial palmar arch from Kaplan?s cardinal line between two groups with complete and incomplete types, respectively. The parameter examined in the group with complete type took the value of 2.13 ? 0.32 cm, while in the group with incomplete type measured 3.33 ? 0.87 cm. Conclusion. The present study showed a very important complexity in the domain of anatomy of the superficial palmar arch with numerous clinical implications. For that reason, a thorough evaluation of the hand circulatory system should be considered while planning surgical procedures in order to avoid operative and postoperative complications.

A Cadaveric Study of Superficial Palmar Arch with Surgical Importance

Introduction: Arterial supply of hand is by two arterial anastomotic arches formed by radial and ulnar arteries and their branches. The anastomoses between the branches of radial and ulnar arteries such as palmar carpal and dorsal carpal arches at the wrist and superficial and deep palmar arches in the palm, maintain a rich arterial supply to the wrist and palm. Effective collateral circulation in palm is essential in peripheral arterial diseases such as Raynaud’s disease and in harvesting radial artery or the ulnar artery for Coronary Artery Bypass Graft (CABG) surgery. Aim: To observe the variations in the formation of superficial palmar arch. Materials and Methods: A descriptive study was performed on 45 formalin fixed upper limbs of both sex in the Department of Anatomy, JSS Medical College, Mysuru, Karnataka, India. The study was conducted during routine dissection of upper limbs for undergraduates as per the Cunningham’s manual for practical anatomy. Few rare variations in the formation of superficial palmar arch and the arterial pattern of hand were noticed. The variations found were classified according to Coleman and Anson classification. Results: Out of 45 limbs, complete arch was found in 36 limbs and incomplete arch in nine limbs. In complete arch type, we found an arterial arcade, bifurcation of ulnar artery and in incomplete arch type, radial-radial anastomosis. Another rare findings of highly tortuous ulnar artery in forearm and in the palm. Conclusion: The findings in the variations of superficial palmar arch are essential in microvascular surgery, forearm fasciocutaneous flap, radial artery and ulnar artery harvesting in coronary artery bypass graft procedure.

VARIATIONS OF THE SUPERFICIAL PALMAR ARCH: A CLINICO-ANATOMICAL CONSIDERATION

Introduction: The superficial palmar arch plays a vital role in the blood supply to the hand. The knowledge of variations in the pattern of superficial palmar arch and its branches, and caliber of these arteries, has become more important for surgeons in reconstructive hand surgeries and radial artery harvesting for myocardial revascularization. The aim of this study was to observe the variations and measure the diameter of contributing arteries of the arches. Materials and methods: In the present study, thirty hands from formalin fixed adult human cadavers were dissected. Normal pattern as well as variations in the arteries contributing to the arch, completeness of arch, and the branching pattern were observed and noted. With the help of a digital caliper, the diameters of ulnar and radial arteries and median artery were taken at the level of the wrist and statistical analysis of the results was done. Results: It was observed that in 96.7 % cases, the superficial palmar arch was complete where there was anastomosis between the arteries forming the arch. In 3.3% cases, the arch was incomplete. The complete arch was divided into radioulnar (36.7%), ulnar (56.7%) and medianoulnar (3.3%) types. The diameter of superficial palmar branch of radial artery was found to be significantly less than the diameter of ulnar artery. (p=0.003). Conclusion: The data obtained on variations and morphometry of superficial palmar arches will certainly be useful in planning and choosing appropriate and safe surgical procedures to prevent inadvertent outcome. KEY WORDS: Palmar arch, blood supply, Hand, radial artery, myocardial revascularization.