Cadaveric study on the variant pattern of superficial palmar arch and its clinical relevance (original) (raw)
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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 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.
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...
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.
Analysis of the vascular pattern in the superficial palmar arch formation
innovative publication
Background: 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 or princeps pollicis artery or radialis indicis artery or median artery. The knowledge about the variations in the formation of SPA is important in reconstructive hand surgery and in radial artery grafts. Objective: The objective of the present study is to identify the arterial patterns in the formation of superficial palmar arch and classify according to its formative tributaries. Material and Methods: The study conducted on 69 formalin fixed hands at Vydehi Institute of Medical Sciences and Research Centre, Bangalore. The vascular pattern of superficial palmar arch was recorded and classified according to the variations. Results: It was found that 96% of SPA were complete and 4% incomplete. Based on Coleman and Anson classification, type A arch was identified in 39%, type B in 17%, type C in 9%, type E in 31% and type G in 4%. Another finding was in 35% cases, the ulnar artery was highly tortuous in its course in the palm. A thin collateral or additional branch was found in 31% of the SPA. Conclusion: These findings on the variations of SPA is essential in microvascular surgery and radial artery harvesting in coronary artery bypass graft procedure.
Variations of the superficial palmar arch in a Sri Lankan perspective: A Cadaveric Study
1st Annual International Conference on Microscopic and Macroscopic Anatomy (CMMA 2014), 2014
Introduction The blood supply of the hand is a complex and challenging area of study. The clinical importance of this area lies in the significant number of surgical procedures such as radial artery conduits in coronary artery bypass grafting (CABG), radial arterial cannulation and reconstructive surgery of the hand. Anatomical variations in the typical blood supply of the hand are common and are an area of extensive research. Methodology-This descriptive study was carried out in the dissecting theatres at the Department of Anatomy, Faculty of Medicine, University of Kelaniya on dissections carried out on 25 cadaveric hands. Results-From the superficial palmar arches studied the following results were obtained. 88% were complete while 22% were incomplete. Specimens with contribution from both the radial and the ulnar arteries for the superficial palmar arches were 80%, while specimens with the contribution solely from the ulnar artery were 12%. 8% hands studied had contributions from the radial, ulnar and the median arteries. Three branches of the radial artery contribute to complete the superficial palmar arch. Of this 60% cadavers had the major contribution from the superficial palmar branch of the radial artery, 24% from the arteria princeps pollicis, and 16% from the first dorsal metacarpal artery. The contribution to the arterial supply of the radial side of the thumb was from the superficial palmar branch of radial artery in 80% of the cadavers while in 20% the contribution was from the arteria princeps pollicis. The contribution to the arterial supply of the ulnar side of the thumb was from the proper palmar digital artery arising from the superficial palmar arch in 44% hands and the contribution in 32% hands was from the arteria princeps pollicis while the contribution in 24% hands was from the first dorsal metacarpal artery. Conclusion It is thus evident that significant anatomical variations of the superficial palmar arch exist in the Sri Lankan population. The arterial supply of the thumb also had significant changes compared to the descriptions given in standard text books.
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...
Indian journal of applied research, 2016
In the hand variation in the completion of the superficial palmar arch is quiet common but the variation we found is quiet different from routine variations. Having knowledge regarding new variations is very important for surgeons and radiologists who involve in the various procedures and surgeries in the region of hand that is the reason we bring forward and publish this variation. In our routine cadaveric dissection in the department of anatomy, Osmania Medical College, Hyderabad, Telangana state, india. We found this variation . In this study we found variant course and branching pattern of radial artey along with variation in the completion of superficial palmar arch. Persistant median artery completing the palmar arch and continuing along with the median nerve up to the common interosseous artery , where it appears as direct branch from the common interosseous artery. Common interosseous artery appears as trifurcating into anterior interosseous artery , posterior interosseou...
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.
Unorthodox superficial palmar arch observed in a South Indian cadaver: a case report
Cases Journal, 2009
Variations in formation of the superficial palmar arch are common. A classic superficial palmar arch is defined as direct continuity between the superficial branch of the ulnar artery and superficial palmar branch of the radial artery. During routine dissection classes to undergraduate medical students we have observed formation of superficial palmar arch solely by superficial branch of ulnar artery without any contribution from the radial artery or median artery. Knowledge of the anatomical variations of the arterial pattern of the hand is crucial for safe and successful hand surgery.