A morphometric study on the superficial palmar arch of the hand

Abstract

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.