Can palmar creases serve as landmarks for the deeper neuro-vascular structures?

M Kwiatkowska,B Ciszek,J Czubak,T Jakutowicz

doi:10.1007/s00276-013-1211-4

M Kwiatkowska, B Ciszek + Show 2 more

Open Access

https://doi.org/10.1007/s00276-013-1211-4

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Abstract

Purpose The aim of this study was the examination of the superficial anatomy of palmar creases and their relation to deeper neuro-vascular structures.MethodsFour creases: distal wrist flexion crease, thenar crease, proximal palmar crease and distal palmar crease were evaluated with reference to the following structures: palmar cutaneous branch of median nerve, palmar cutaneous branch of ulnar nerve, the nerve of Henle, transverse palmar branches from ulnar nerve, recurrent motor branch of median nerve, radial proper palmar digital nerve to the index and the ulnar proper palmar digital nerve to the thumb, Berrettini’s communicating branch, ulnar nerve and artery, superficial palmar arch. We performed dissections of 20 cadaveric upper limbs derived from a homogenous Caucasian group. In our study we measured the location of surgically important structures with reference to palmar skin creases.Results Among the other observations we noticed that the palmar cutaneous branches of the median and ulnar nerves were located at least 0.5 cm away from the thenar crease. The superficial palmar arch was found between the thenar and proximal palmar crease and never crossed the proximal or distal palmar creases.ConclusionsThese anatomical dissections will provide reference material for further ultrasound studies on the arrangements of neuro-vascular structures in reference to superficial palmar creases.

Highlights

The palmar creases have been the subject of interest to scientists for centuries
The superficial palmar arch was found between the thenar and proximal palmar crease and never crossed the proximal or distal palmar creases
The thenar crease usually intersects the lateral side of the proximal palmar crease and curves obliquely across the palm to intersect the distal wrist crease near the wrist centre

Summary

Introduction

The palmar creases have been the subject of interest to scientists for centuries. There are very few current references addressing the anatomy of palmar creases and its clinical significance. In the literature there have been descriptions of the palmar creases in reference to osseous structures or genetically inherited disorders [5, 7, 28]. The surgical approach to the palmar surface of the hand is usually straightforward, it may be occasionally a challenging task. There are several small cutaneous branches of nerves that are at risk when approach is being made to operate the hand. In our study for the first time we decided to use the natural palmar lines-creases as a guide to localise precisely the important neuro-vascular structures

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