Bridging the Gap in Hand Replantation: Use of the Common Digital Artery for Completion of the Superficial Palmar Arch (original) (raw)

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.

Digit and hand replantation

Archives of Orthopaedic and Trauma Surgery, 2009

For the past 45 years, the advent of microsurgery has led to replantation of almost every amputated part such as distal phalanx, finger tip, etc. Replantation of digits and hand can restore not only circulation, but also function and cosmetic of the amputated part. The goals of replantation are to restore circulation and regain sufficient function and sensation of the amputated part. Strict selection criteria are necessary to optimize the functional result. The management of this type of injuries includes meticulous preoperative management, microsurgical experience and continuous postoperative care. Among various factors influencing the outcome, the most important are the type and the level of injury, ischemia time, history of diabetes, age, sex, and smoking history. During the replantation procedure, bone stabilization, tendon repair, arterial anastomoses, venous anastomoses, nerve coaptation, and skin coverage should be performed. All structures should be repaired primarily, unless a large nerve gap or a flexor tendon avulsion injury is present. Adequate postoperative evaluation is mandatory to avoid early or late complications. To improve functional results, many replantation patients may need further reconstructive surgery.

Variations in Superficial Palmar Arch: Case Series with Clinico-anatomical Perspective

Medeniyet Medical Journal

The superficial palmar arch (SPA) is an important anastomotic network primarily formed by the superficial branch of the ulnar artery with one of the superficial branches of the radial artery. SPA variations were observed in three out of 20 cadaveric hand specimens. Two cases of unilateral incomplete SPA and the third case of a unilateral ulnar-to-median complete SPA were recorded. The incomplete SPA was located superficial to the flexor digitorum tendons and deep to the palmar aponeurosis. SPA in the remaining 17 hands was anatomically normal, with major contributions from the superficial palmar branch of the ulnar artery and minor contributions from the superficial palmar branch of the radial artery. These variations are clinically important, especially during procedures like arterial blood sampling, cardiac catheterization, and hemodialysis. Thus, anatomical variabilities in this region may cause complications with vascular occlusion if not ascertained before the procedure.

Mid-palm hand amputation: Reconstruction of the superficial palmar arch

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2013

The versatility of the superomedial pedicle with various skin reduction patterns. Plast Reconstr Surg 2007;120(6): 1466e76. 3. Hall-Findlay EJ. A simplified vertical reduction mammaplasty: shortening the learning curve. Plast Reconstr Surg 1999;104(3): 748e59 [discussion 760e3]. 4. James A, Verheyden C. A retrospective study comparing patient outcomes of wise pattern-inferior pedicle and vertical patternmedial pedicle reduction mammoplasty. Ann Plast Surg 2011; 67(5):481e3.

Anatomical Study of Superficial Palmar Arch and Its Variations with Clinical Significance

International Journal of Anatomy and Research

Background: Superficial Palmar Arch (SPA) is an arterial arcade usually formed by the continuation of ulnar artery and the superficial branch of radial artery. Variations can occur in the vessels contributing to the formation of SPA. Knowledge of such variations will be very much helpful to microvascular surgeons, plastic surgeons and orthopaedicians to bring a better outcome in their surgical procedures. Also, it will be useful to the cardiovascular surgeons to carryout radial artery harvesting procedures for the purpose of Coronary Artery Bypass Grafting. The main objective is to study the different patterns of formation of the superficial palmar arch with an emphasis on their clinical importance.

Subtotal reconstruction of the thumb by transposition of index finger

The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 1985

A case of subtotal reconstruction of the thumb is described. The reconstruction was carried out as a staged procedure with an intact index finger transposition, followed by opposition transfer using the abductor digiti quinti muscle after three weeks. Twenty-eight months postoperatively, power grip and precision grip were restored despite destruction of the thenar muscles.