Study of variant superficial palmar arch entirely formed by the ulnar artery

AbstractThe anatomical variations in the arterial supply of the palm are frequently reported. One such variation reported during routine dissection for undergraduate medical students in our college is the absence of superficial palmar arch and presence of persistent median artery. The arterial supply to the palm is in the form of superficial and deep palmar arches. In the present case the median artery and ulnar artery supplies the palm without forming an arch on the left extremity. Awareness of variations in the vascular pattern of the palm is clinically important in case of angiographic procedures and surgical emergencies.

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Bilateral superficial median arteries

American Journal of Anatomy ◽

10.1017/s0021878299004690 ◽

1999 ◽

Vol 194 (3) ◽

pp. 475-477

Author(s):

TOSHIO NAKATANI ◽

ATSUSHI IZUMI ◽

SHIGENORI TANAKA

Keyword(s):

Clinical Importance ◽

Ulnar Artery ◽

Crossing Over ◽

Upper Limbs ◽

Superficial Palmar Arch ◽

Arterial Variation ◽

Palmar Arch ◽

Flexor Muscles ◽

Median Artery ◽

Superficial Ulnar Artery

A superficial artery may be present in the forearm, arising from the axillary, brachial or superficial brachial arteries and crossing over the origin of the flexor muscles of the forearm to reach the palm (Adachi, 1928; Bergman et al. 1988). When this superficial artery continues as the normal ulnar artery accompanying the ulnar nerve at the wrist, it is referred to as the superficial ulnar artery, with an incidence of ∼4%. When the artery passes below or superficial to the flexor retinaculum in the middle of the forearm, sometimes continuing to join the superficial palmar arch, it is called the superficial median artery, with an incidence of ∼1%. We have observed a relatively rare variation involving the presence of a superficial median artery in both upper limbs. We discuss the clinical importance and the developmental aspects of this arterial variation.

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

International Journal of Anatomy and Research ◽

10.16965/ijar.2021.156 ◽

2021 ◽

Vol 9 (3.3) ◽

pp. 8097-8102

Author(s):

Suman Udupi ◽

◽

Pushpa Gowda ◽

Keyword(s):

Radial Artery ◽

Index Finger ◽

Ulnar Artery ◽

Superficial Palmar Arch ◽

Palmar Arch ◽

Artery Cannulation ◽

Complete Type ◽

Cardio Vascular ◽

Interesting Area

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.

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

International Journal of Anatomy and Research ◽

10.16965/ijar.2020.231 ◽

2020 ◽

Vol 8 (4.2) ◽

pp. 7817-7822

Author(s):

Pooja Dawani ◽

◽

Anita Mahajan ◽

Sabita Mishra ◽

Neelam Vasudeva ◽

...

Keyword(s):

Radial Artery ◽

Blood Supply ◽

Myocardial Revascularization ◽

Ulnar Artery ◽

Vital Role ◽

Superficial Palmar Arch ◽

Palmar Arch ◽

Human Cadavers ◽

Median Artery ◽

Digital Caliper

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.

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Anatomical variations of the superficial palmar arch and its clinical relevance

Vojnosanitetski pregled ◽

10.2298/vsp201020014m ◽

2021 ◽

pp. 14-14

Author(s):

Milos Malis ◽

Slobodan Kapor ◽

Laslo Puskas ◽

Milan Aksic ◽

Valentina Blagojevic ◽

...

Keyword(s):

Statistical Significance ◽

Circulatory System ◽

Ulnar Artery ◽

Anatomical Variations ◽

Terminal Branch ◽

Superficial Palmar Arch ◽

Palmar Arch ◽

Area Of Interest ◽

Complete Type ◽

Significant Difference

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.

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

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v14i1.33995 ◽

2021 ◽

Vol 14 (1) ◽

pp. 19-23

Author(s):

Prakash Baral ◽

Rami Shrestha ◽

Subash Sapkota ◽

Supana Koju ◽

Binod Chaudhary

Keyword(s):

Wrist Joint ◽

Ulnar Artery ◽

Superficial Palmar Arch ◽

Normal Pattern ◽

Palmar Arch ◽

Male And Female ◽

Vertical Incision ◽

Significant Difference ◽

Palmar Aponeurosis ◽

Pattern Distribution

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.

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Anatomical Study of the Superficial Palmar Arch, its Relation to the Kaplan Cardinal Line and Literature Review

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0038-1676046 ◽

2018 ◽

Vol 46 (02) ◽

pp. 096-105

Author(s):

Claudia Arroyo Berezowsky ◽

Alejandro Gutiérrez ◽

Jimena Fresnedo ◽

José Montero

Keyword(s):

Anatomical Study ◽

Ulnar Artery ◽

Vascular Supply ◽

Superficial Palmar Arch ◽

Palmar Arch ◽

Reconstructive Procedures ◽

Anatomical Variants ◽

Type Ia ◽

Safety Limit ◽

Multiple Variants

Introduction The superficial palmar arch is the main contributor to the vascular supply of the hand. Numerous anatomical variants have been described and there are multiple classifications of the superficial palmar arch available. The Kaplan cardinal line is used occasionally as a reference to identify the deep structures of the hand. However, there are also multiple variants of the line and multiple reports regarding the structures that can be identified with it. Material and Methods Ten anatomical dissections of hands were performed in seven cadaveric specimens. The anatomical variants of the superficial palmar arch were recorded, as well as their relationship with the Kaplan cardinal line. A review of the available literature was made. Results According to the classification by Coleman et al, the most common type was the complete superficial palmar arch, present in seven hands, while the incomplete superficial palmar arch was found in three hands. The most frequent complete palmar arch was type IB, followed by type IIB, and finally type IA and type IIA. The most common relation was with the Kaplan cardinal line type A to the apex of the arch and with type B to the curvature of the ulnar artery. Conclusions There is a great anatomical variability in the superficial palmar arch. There was a greater frequency of the complete superficial palmar arch, with the ulnar artery being the dominant vascular supply. The Kaplan cardinal line can be used as a safety limit to avoid the superficial palmar arch if it is drawn to intersect the pisiform bone. Clinical Relevance It is important to be aware of the anatomical variants of the superficial palmar arch, as well as of its relationship with the superficial structures of the hand to be able to perform invasive or reconstructive procedures and to preserve the vascularity of the hand.

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Palmar Arch: Anatomical And Surgical Correlation in Trauma

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.2016.029 ◽

2018 ◽

Vol 3 (3) ◽

pp. 951-958

Author(s):

Agustín Algieri ◽

Rubén Algieri ◽

Homero Bianchi ◽

María Ferrante ◽

Carolina Brofman

Keyword(s):

Radial Artery ◽

Ulnar Artery ◽

Anatomical Variations ◽

Morphometric Study ◽

Superficial Palmar Arch ◽

Palmar Arch ◽

Complete Section ◽

Starting Point ◽

Classic Pattern ◽

Median Artery

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 hundred1(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 also carried out. Most frequently the radial artery forms the deep palmar arch with the deep palmar branch of the 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 most found. Two cases, one entire section of the radial artery at the wrist and the other with complete section of ulnar artery with involvement of the ulnar nerve are described. It is essential to a proper understanding of the palmar arches for a suitable surgical approach to hand. The importance of the presence or absence, as well 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.

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Palmar arch anatomy: Ajmer Working Group classification

Vascular ◽

10.1177/1708538115576428 ◽

2015 ◽

Vol 24 (1) ◽

pp. 31-36 ◽

Cited By ~ 8

Author(s):

Rajendra Gokhroo ◽

Devendra Bisht ◽

Sajal Gupta ◽

Kamal Kishor ◽

Bhanwar Ranwa

Keyword(s):

Collateral Circulation ◽

Ulnar Artery ◽

Type A ◽

Artery Occlusion ◽

Superficial Palmar Arch ◽

Palmar Arch ◽

Digital Ischemia ◽

Allen’S Test ◽

Type C ◽

Allen's Test

Introduction Forearm arteries are frequently used as workhorse site for cardiac catheterization, bypass grafting and haemodialysis access. There is paucity of data on palmar circulation in live human being and only cadaveric data are available till date. We, therefore, made an attempt to look at the various patterns of sufficient or insufficient palmar arch circulation and various anomalies of forearm arteries, to discuss their clinical implications. Methods and results We obtained the forearm and hand arteriograms of patients (n = 302) through radial (n = 200) and ulnar routes (n = 102). Modified Allen’s test was normal in all of our patients. On the basis of predetermined parameters angiograms were analysed and findings were divided into three groups. These three groups were further classified as type A, type B, type C superficial palmar arch. Conclusion We concluded that type A superficial palmar arch is most suitable for providing adequate collateral circulation in case of harvesting of forearm vessel, whereas type C superficial palmar arch appears to be highly susceptible for digital ischemia in case of radial or ulnar artery occlusion. Modified Allen’s test alone is not justifiable for documenting good collateral circulation and it should be supplemented by other tests to document good collateral circulation before proceeding to any radical procedure.

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

Colombia Medica ◽

10.25100/cm.v52i2.4521 ◽

2021 ◽

Vol 52 (2) ◽

pp. e5024521

Author(s):

Daniela Calderón Ardila ◽

Daniel Raúl Ballesteros Larrota ◽

María Andrea Calderón Ardila ◽

Luis Ernesto Ballesteros Acuña

Keyword(s):

Young Male ◽

Ulnar Artery ◽

Vascular Lesions ◽

Superficial Palmar Arch ◽

Palmar Arch ◽

Anatomical Variant ◽

Anterior Interosseous Artery ◽

Left Limb ◽

Interosseous Artery ◽

Median Artery

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.

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