Bridging the Gap in Hand Replantation: Use of the Common Digital Artery for Completion of the Superficial Palmar Arch (original) (raw)
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Reconstruction of the Superficial Palmar Arch Using the Subscapular Arterial System
Plastic and Reconstructive Surgery - Global Open, 2019
BACKGROUND Hypothenar hammer syndrome (HHS) involves repetitive blunt trauma or vibrational forces to the ulnar aspect of the hand, causing injury to the ulnar artery and potentially leading to thrombosis and distal ischemia. 1 Signs and symptoms of hypoperfusion or ischemia to the ulnar digits may include pain, coolness, and pallor. 2 Neuropathy of the adjacent ulnar nerve may occur. 3 Conservative measures are appropriate for most cases and may include activity modification, smoking cessation, cold avoidance, and/or calcium channel blockers. 2,4 Operative management is indicated when nonoperative management fails, or if critical ischemia is present. Reconstruction of the ulnar artery with venous and arterial interposition grafts has been described. 4-9 Venous donor sites include the greater saphenous vein, dorsal venous arch of the foot, or flexor aspect of the arm but have high thrombosis rates. 6,7,9 Previously described arterial donor sites include the descending branch of the lateral femoral circumflex artery, the deep inferior epigastric artery, or the serratus branch of the thoracodorsal artery. 4,8,9 We present a case of acute HHS that resulted in a large, complex arterial defect in the hand after resection of thrombosed arterial segments. Successful treatment utilized an interposition graft from the subscapular arterial system, which included multiple branches to reconstruct the arterial defect with 1 contiguous graft. CASE REPORT A 53-year-old right-hand-dominant carpenter presented with a 2-week history of right-sided intermittent median and ulnar nerve paresthesias and ulnar-sided hand pain. His symptoms worsened acutely with the development of bluish discoloration and exquisite pain to the tip of the fourth digit. History revealed frequent repetitive trauma to the hypothenar eminence when he used the ulnar aspect of his hand "like a hammer" to forcefully turn a large wrench. Medical history included well-controlled type 2 diabetes with no history of smoking, cardioembolic disease, or coagulopathy. The pulp of the fourth digit was cool to touch with a bluish hue, decreased capillary refill, and pain to
Anatomical Variations of the Superficial Palmar Arch- a Cadaveric Study
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND There is lot of variability in the formation of the superficial palmar arch and its contributing arteries. The superficial palmar arch is usually formed by the superficial branch of ulnar artery and completed by one of the branch of radial artery, i.e. superficial palmar branch, arteria radialis indices or arteria princeps pollicis. It is rarely completed by the axis artery of the upper limb, i.e. median artery, which accompanies the median nerve type. In some cases, it is of incomplete nature where digital branches are arising separately from the superficial branch of ulnar artery on one side and from one of the branches of radial artery on the other side. A study of the variations of the palmar arch will not only help anatomists, but also vascular surgeons while doing reconstructive surgeries of the hand to avoid possible complications.
A Cadaveric Study of Superficial Palmar Arch with Surgical Importance
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2021
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...
Variations in the Pattern of the Deep Palmar Arch of the Hand and Its Surgical Importance
Cureus
Background The deep palmar arch is formed by anastomosis of the continuation of the radial artery with the deep palmar branch of the ulnar artery. With recent advances in microsurgical techniques for vascular repair, the knowledge of variations in the arteries of the hand, as well as the caliber of these arteries, has become more important for surgeons. Additionally, radial artery harvesting for myocardial revascularization is being performed nowadays, for which collateral circulation in the hand through the palmar arches is a prerequisite. Therefore, this study was conducted to study the patterns of the deep palmar arch and perform the morphometry of the arch. Methodology In this study, 30 hands (16 right and 14 left) from formalin-fixed adult human cadavers were dissected to observe the completeness, formation, and branching pattern of the deep palmar arch. The length of the arch was measured using a thread and scale. The diameters of the forming arteries and branches of the arch were measured at their origin using a digital vernier caliper. Results All deep palmar arches were complete. The arches were classified into two types based on whether the superior or inferior deep palmar branch of the ulnar artery completed the arch. Another classification was based on the interosseous space through which the radial artery or its branch entered the palmar region to complete the deep palmar arch. The length of the arch was 4.2 ± 0.47 cm on the right side and 4.0 ± 0.6 cm on the left side. The diameters of the deep palmar branch of the radial and ulnar arteries at their origin were 4.02 ± 0.48 mm and 1.90 ± 0.36 mm, respectively. No significant difference was found between the right and left sides. Conclusions The anastomosis was found between radial and ulnar arteries in all cases of the deep palmar arch. Therefore, it can be safe to sacrifice the radial artery in procedures such as radial artery harvesting and radial artery flap transfer. The knowledge of variations and morphometry of the arch will facilitate vascular repair surgeries on hands.
An anatomical investigation of the superficial and deep palmar arches
Folia Morphologica, 2017
Background: The superficial palmar arch (SPA) and deep palmar arch (DPA) provide the dominant vascular supply to the hand. The SPA is considered to be highly variable and can be classified as either complete or incomplete. The simplest definition states that the anastomosis between the vessels contributing to the arch represent a complete arch, while an incomplete arch is described as characterised by an absence of anastomosis between the vessels contributing to it. This study aimed to describe the anatomical landmarks, formation and branching patterns of the SPA and DPA. In this study, the SPA and DPA were dissected in 50 specimens (n = 100 adult hands), respectively. Materials and methods: A complete SPA was observed in 92% of specimens and classified into three types. In Type A (44%), the SPA was formed by the anastomosis of the superficial palmar branch of the radial artery with the ulnar artery. Type B (46%) was formed by the ulnar artery alone and Type C (2%) was formed by anastomosis of the ulnar artery with the superficial palmar branch of the radial artery and the persistent median artery. Results: An incomplete SPA was observed in 8% of the specimens and divided into three types formed by the radial and ulnar arteries. The DPA was divided into five types viz. Type G (72%), where the DPA was formed by anastomosis of the deep palmar branch of the radial artery (DPBRA) with the deep palmar branch of the ulnar artery (DPBUA). Type H (12%), was formed by anastomosis of the DPBRA, the DBUA and the interosseous artery. Type I (8%), was formed by the anastomosis of the DPBRA with the superior and inferior DPBUA. Type J (4%), the deep ulnar artery had two branches whereby either one branch anastomosed with the DPBRA to form the DPA. Type K (4%), the DBUA exhibited two deep branches with one branch anastomosing with the DPBRA to complete the DPA. Conclusions: The interosseous artery anastomosed with either the DPA or the additional DPBUA. Knowledge of the variability of the SPA and DPA is crucial for safe and successful hand surgeries.
Cadveric Study of Superficial Palmar Arch
IOSR Journals , 2019
Awareness of the anatomical variations of the blood supply of the hand is necessary for the anatomist but also for surgeons when considering hand surgeries. The objective of this study was to find the incidence of anatomical variations of the superficial palmar arch and describe any anatomical variation. 18 cadavers were observed for this during routine dissections of MBBS graduates in Andhra Medical College, Visakhapatnam. In one of the cadavers there is no superficial palmar arch but the ulnar artery alone is seen suplying the medial 3 digits. And the superficial palmar branch of radial artery never joined the ulnar or niether of its branches joined to complete the arch. But in turn the superficial palmar branch of Radial artery supplied the thumb and index finger. Knowledge of vascular anamolies of the hand should be borne in mind to avoid iatrogenic injuries during surgery of the hand.
Variations of the Superficial Palmar Arch: A Clinico-Anatomical Consideration
International Journal of Anatomy and Research, 2020
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 co...
Unilateral Incomplete Superficial Palmar Arch: A Case Report
International Journal of Anatomy and Research, 2015
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.
Cadaveric study on the variant pattern of superficial palmar arch and its clinical relevance
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Superficial palmar arch is one of the important arterial arcade supplying the human hand. Vascular supply to human hand is one of the challenging areas showing many morphological variations. Presently the modern medical technology has shown vast improvement, it is better to have a detailed knowledge of arterial supply to the hand because significant number of surgical procedures such as canulation of radial artery, radial artery auto grafting in coronary bypass surgeries are carried out. Knowledge of vascular pattern is more important in reconstructive hand surgery. Materials and Method: 40 human hands procured from 20 embalmed cadavers of A.J. Institute of Medical science, Mangalore used for the study. Dissection of arch was carried out and variations of superficial palmar arch with regards to formative arteries and branching pattern are studied in detail. Results: Out of 40 hands studied 31 (77.5%) hands showed complete and 9(22.5%) hands showed incomplete superficial palmar arches. In majority of hands (26) complete arch were formed by the direct continuity between ulnar artery and superficial palmar branch of radial artery. In 2 hands arch was formed by ulnar artery and median artery. Out of 9 incomplete arches, 7 hands showed arch formed mainly by ulnar artery and in 2 hands ulnar artery and superficial palmar branch of radial artery without anastomosis. Conclusion: The results of this study will be helpful for surgeons, intervention radiologist and orthopaedicians for the successful outcome of any hand surgeries.
A morphometric study on the superficial palmar arch of the hand
Surgical and Radiologic Anatomy, 2006
The vascular anatomy of the hand is a complex and challenging area and has been the subject of many studies. Knowledge of the vascular patterns and diameters of the hand gained more importance with improvements in microsurgical techniques in reconstructive hand surgery. We evaluated 50 hands (26 left, 24 right) of 26 formalin preserved cadavers to determine the superficial palmar arch, its branches and contributing vessels with special attention to the diameters. The symmetry of the types was also evaluated in detail for the first time in the literature. Measurements were made with the help of a digital caliper. The diameters of the ulnar, radial and median arteries were taken at the level of the wrist while the common palmar digital arteries, hypothenar branches and the superficial palmar branch of the radial artery were measured at their origin. Two types of superficial palmar arch were found and defined as complete (43/50 hands) and incomplete arches (7/50 hands). The complete arches were divided into four subgroups and incomplete arches into three subgroups. Most cases were found at the complete AI group (17 hands). Comparison of the arterial diameters showed the ulnar artery was the dominant vessel of the palm. The diameters of the common palmar digital arteries were not different with regard to complete or incomplete arches and between both sides. It looks safe to sacrifice one of the radial or ulnar arteries in some arterial interventions including radial artery cannulation, radial forearm flap and radial or ulnar artery harvesting for bypass grafting if the arch is complete. But we still recommend the noninvasive tests like modified Allen test or Doppler ultrasonography, before performing an invasive arterial intervention. We propose the radiologists to incorporate the median artery into the Doppler dynamic test in particular the existence or the absence of anastomoses between radial and ulnar arteries.