Common Digital Artery Research Articles

Morphometric Overview on the Vascularization in the Egyptian Domestic Cat (Felis catus) Hind Paw

The present study was conducted on 16 fresh cats’ hind paws to investigate the anatomical description of the arterial blood supply at the level below the tarsus, which considered as the potential site for intra- operation hemorrhage and thrombus formation. Six cat hind paws with intravascular latex injection, four limbs for surgical approach and three cats used in Duplex ultrasonography technique as a tool for estimating the diameter of the arteries of hind paw of potentially clinical relevant. This work reported that, the hind paw of the cat was supplied by branches from the saphenous A. and the cranial tibial A. Both dorsal and planter aspects of the paw was supplied by superficial and deep sets of arteries; the superficial set consists of the common digital arteries II, III and IV While, the deep set was formed of the metatarsal arteries II, III and IV.

Plantar flaps based on perforators of the plantar metatarsal/common digital arteries.

Because of the unique characteristics of its integument, the affirmation "replacing like with like" becomes more than evident in the reconstruction of defects of the ultraspecialized plantar skin. But, the paucity of local resources, and especially in the forefoot, transforms this attempt in a very challenging problem. Many techniques, including skin grafts and various types of flaps were used in the management of defects in the forefoot. We present a new useful flap in the reconstruction of skin defects in the forefoot, based on small perforator vessels originating either from the plantar metatarsal arteries or plantar common digital arteries. Starting with June 2011, this flap was performed, as plantar transposition perforator flap, plantar propeller flap, or plantar propeller perforator plus flap, in seven patients with ulcers over the plantar forefoot. During a follow-up of 7 to 17 months (mean, 9.8 months), the local evolution regarding flap integration, pain, relapse, sensitive recovery, donor site, and footwear quality was analyzed. We registered a 100% survival rate of the flaps, with delayed healing in only one case. The gait resumption was possible after 6 weeks in all cases. This new flap, based on small perforator vessels from the plantar metatarsal or common digital arteries, and which provides a good, stable, and sensory recovery, seems to be a promising method in the reconstruction of plantar skin defects over the metatarsal heads.

Volar perforators of common digital arteries: an anatomical study

The palmar triangle is an area vascularized by perforator arteries arising from the common digital palmar arteries. The aim of this article was to perform an anatomical study of common digital palmar arteries perforators. Twelve injected specimens were included in this study. The purpose was to quantify the number of perforator arteries of each common digital palmar arteries in the 2nd, 3rd, and 4th intermetacarpal space, measure distances between them, between the distal perforator and corresponding commissure, and the distance between the proximal perforator and the superficial palmar arch. Four to eight perforators were arising from common digital palmar arteries of the 2nd, 3rd, and 4th intermetacarpal space. The average distance between perforator arteries was 6.5 mm, between superficial palmar arch and proximal perforator artery - 8.2 mm, between the distal perforator artery and corresponding commissure - 6.3 mm.

UNILATERAL INCOMPLETE SUPERFICIAL PALMAR ARCH VARIATION

In this case report, we want to present a truly incomplete superficial palmar arch on right side which is not completed by any of the branches of radial or median artery. On the left side of the same individual, the SPA is classical, completed by superficial branch of radial artery. The areria nervi mediana is not participating in arch formation on both the sides. Four palmar digital branches: digital branch to medial side of little finger and three common palmar digital arteries to the adjacent sides of medial four digits are seen arising from incomplete palmar arch. Awareness of the variation among the individual patient’s both hands need to be well thought-out during hand surgeries.

Variation of Superficial Palmar Arch a Case Report

The anastomoses between radial and ulnar arteries in the palm play a significant role in diseases of the palm through collateral circulation. During routine dissection of the upper limb of a 45-year-old male cadaver, we observed the superficial palmar arch (SPA) formed exclusively by the superficial branch of the ulnar artery. The superficial palmar branch of the radial artery entered the hand above the thenar muscles and provided palmar digital branches to the radial side of the index finger and the ulnar side of the thumb, without any contribution to the SPA. However, the radial side of the thumb was supplied by a branch from the deep palmar arch. The superficial branch of the ulnar artery gave origin to three common palmar digital arteries to supply the contiguous sides of the index, middle, ring and little fingers. It also provided origin to a digital branch to the ulnar side of the little finger. Keywords: Radial artery, Superficial palmar arch, Ulnar artery I. Introduction The anastomoses between radial and ulnar arteries in the palm play a significant role in diseases of the palm through collateral circulation. During routine dissection of the MBBS students we have seen that the hand of a75 year-old male cadaver, showed variation in the completion of the superficial palmar arch (SPA) formed exclusively by the superficial branch of the ulnar artery. (The superficial arteries of the hand formed several diversified patterns that permitted into well-defined categories. About two-third of the SPA is formed by the ulnar artery alone; a further third is completed by the superficial palmar branch of the radial artery and a third either by the arteria radialis indicis or by the princeps pollicis or by the median artery. A classic type of SPA in which the superficial branch of the radial artery joins the superficial branch of the ulnar artery is found only in 34.5% of the cases. There are many reports regarding formation of SPA. In a study by Coleman et al., the complete arch was found in 78.5% of the cases and incomplete arch in the remaining 21.5%, and this formed a major underlying factor in the aetiology of digital ischaemia. Ikeda et al. conducted stereoscopic arteriography of 220 cadaver hands and reported complete SPA in 96.4% of the cases, and only 3.6% had an incomplete arch. Gellman et al. showed a complete SPA in 84.4% and Al Turk and Metcalf reported complete SPA in 84% of the cases.

Digital Neural Loops: Classification and Implications of Variation in Hand Surgery

The "neural loop" describes a digital artery passing through a digital nerve, after which both the structures progress distally to supply the digit. While rare, past descriptions refer to neural loops located around the common palmar digital arteries, with no reports of more distal loops. We describe a case in which a distal neural loop was identified, with the ulnar proper palmar digital nerve (PPDN) to the long finger split, and reconstituted around the radial proper palmar digital artery (PPDA) to the ring finger. This variation was explored within the previously reported classification systems for such neural loops in the literature. Previously reported neural loops have been localized to the palm, without report of formation of a neural loop by the penetration of a PPDA. A new classification of neural loops is presented in this context on the basis of anatomical location. This new model, of separating neural loop position into anatomical levels, provides more information to the hand surgeon when dissecting and raising vascular pedicles for flaps reconstruction.

Palmar Island Flaps Used to Cover Dorsolateral Finger Defects

Soft-tissue injuries of the hand are devastating injuries that may need coverage. Dorsal and/or lateral defects of the fingers with exposed tendon and/or bone are challenging obstacles in reconstructive hand surgery. There are several options for coverage of dorsal defects of the fingers, but all have shortcomings. A reliable 1-stage local flap to coverage the dorsolateral finger defects is needed. Anatomic study of Omokawa and their colleagues showed that palmar area is supplied by several perforators from the superficial palmar arch, and the common and proper digital arteries. The distal portion of the palm has numerous (range, 8 to 15) and large diameter (range, 0.1 to 0.5) perforators with good vascularity. Therefore, on the basis of this anatomic consideration, palmar island flap can be elevated. This flap is a simple, reliable, effective, and versatile flap which could be borne in mind as the best option to the hand surgeons treating soft-tissue defects of the hand.

A Rare Finding of the Superficial Palmar Arch-Developmental and Clinical Significance

The ulnar artery provides a major blood supply to the hand in the form of the superficial palmar arch, with the assistance of the radial artery. A rare pattern of the superficial palmar arch was observed in a formalin fixed, male cadaveric left hand. The ulnar artery was only involved in the formation of this arch, which provided three common palmar digital arteries which ran into the second, third and the fourth spaces between the corresponding digits and one proper palmar digital artery which ran along the ulnar side of the little finger. The main trunk of the ulnar artery bifurcated to supply the thumb and the index finger. The superficial branch of the radial artery did not participate in the arch formation. The arch was completed by the radial artery proper on the dorsolateral surface of the hand, after joining the point of bifuracation of the ulnar artery.

Symptomatic Neural Loop Causing Hemidigital Anesthesia: Case Report

Digital neural loops were identified over a century ago and are common findings in cadaveric studies of palmar and digital anatomy. Symptomatic digital neural loops are rare. We report a case of hemidigital anesthesia resulting from a proper digital nerve neural loop penetrated by its common digital artery in the palm. After neurolysis of the median nerve and the common and proper digital nerves to the third webspace, we transected the common digital artery, transposed it out of the neural loop, and repaired it. The patient's sensory symptoms fully resolved over 6 weeks. The differential diagnosis, diagnostic workup, and surgical treatment are reviewed.

Hydrofluoric Acid Burn of the Hand – A Rare Emergency

IntroductionWe report on successful endovascular treatment of a hydrofluoric acid burn to the hand. ReportA worker complained of severe pain in the fingers D II to D V after injury with 60% hydrofluoric acid. A digital subtraction angiography showed vasospasm of the common palmar digital artery. We selectively applied 20% calcium gluconate intra-arterially.After treatment all arteries were perfused. Alprostadil, acetylsalicylic acid and clopidogrel were administered in conjunction. Pain symptoms improved and sensory and motor functions were restored. DiscussionImmediate angiography and intra-arterial application of calcium gluconate are recommended to treat hydrofluoric acid burn to a limb.

Double superficial palmar arch - a case report

AbstractThe superficial palmar arch is formed predominantly by the ulnar artery with a contribution from the superficial palmar branch of the radial artery. However, the arch formation is highly variable. The knowledge of the relationship, course and variations of the arch are important in various surgical procedures. Incomplete ligation of vessels in cases of variable arterial arch can lead to serious secondary hemorrhage in the depth of the wounds of hand. In the present study, a case of double superficial palmar arch is reported in the right hand of a male cadaver. The radio-ulnar type of arch had a proximal and a distal part from where the common palmar digital arteries arose.

Evaluation of the forearm blood flow with C.W. Doppler in patients submitted to myocardial revascularization with the radial artery

Before harvesting the radial artery for coronary bypasses, investigating forearm vascularization to avoid postoperative ischemia of the hand is mandatory. The study involved 192 consecutive patients, 155 males and 37 females age 39–76 years (mean 56.1). The CW Doppler static and dynamic test was performed to evaluate the patency of the upper limb's arteries and the adequacy of the ulnar supply in the nondominant arm. The use of the radial artery was contraindicated in 14 patients (3 for stenosis of the subclavian artery and 11 for inadequate collateralization). One hundred and four patients were operated on with the radial artery used as a graft; another conduit was used in the remaining 74 patients. The vascularization of the hand was restudied within 10 days in all patients who underwent surgery; in 82 patients, it was studied again at 1 year. The early Doppler control showed a significant increase of blood flow velocities in the ulnar artery, with a flow redistribution in the common digital palmar arteries (decreased in the 1st and slightly increased in the 3rd). The late Doppler control showed superimposable findings. No local ischemic complications were observed after radial artery removal. Three patients showed thumb dysesthesias with no functional damage, probably due to surgical trauma of the radial nerve collateral branches. The authors conclude that a Doppler study is a useful tool to detect patients for radial artery surgical removal and to predict the efficacy of the ulnar supply through the distal anastomosis.

Variation on the Formation of Superficial Palmar Arch. A cadaveric Study

The anatomy of the palmar vascular arches is a complex and challenging area. Understanding the vascular patterns of the hand and their variations is very important for surgeons, radiologists and anatomists because of innovative microsurgical techniques in reconstruction of a traumatized hand, and may be useful for graft surgeries, when the arteries of the upper limb are used for coronary artery bypass. The description of a complete arch refers to the existance of an anastomosis between the superficial palmar branches of ulnar and radial arteries, or in cases in which the ulnar artery alone supplies all the fingers an the ulnar side of the thumb. An incomplete arch was defined when it only supplies the 5th, 4th, and 3rd digits. We evaluated 36 hands belonging to 19 formalin preserved cadavers to determined the pattern of the superficial palmar arch, its branches, and contributing vessels. We discard two specimen. The ulnar artery was injected with red colored latex. In addition to the frequently encountered types of superficial palmar arch, a myriad of very rare cases in which the princeps pollicis and radialis indicis arteries arising from the first and second dorsal metacarpal arteries, and from a voluminous superficial palmar branch of radial artery. In other cases the palmar metacarpal arteries gave origin to the common palmar digital arteries.

Hypothenar Hammer Syndrome

Repetitive trauma to the hypothenar eminence can cause the ulnar artery to become aneurysmal, thrombose, or send emboli to the digital arteries. The symptoms and signs are also known as the hypothenar hammer syndrome. We postulate that an arterial autograft is a superior conduit to the traditional vein graft. In this article, we report 3 cases (2 in 1 patient) of reconstruction of the distal ulnar artery with the descending branch of the lateral circumflex femoral artery (LCFA). Two patients, ages 45 to 50 years, had severe ischemic complaints of the ulnar fingers. Arteriograms confirmed occlusion of the distal ulnar artery without direct perfusion of the superficial palmar arch. All reconstructions were carried out with the descending branch of the LCFA. From the ulnar artery at wrist level to the superficial palmar arch and the involved common digital arteries. Patency was certified during follow-up with color-coded Duplex sonography at 6 to 28 months. Preoperative complaints like cold intolerance and other ischemic symptoms disappeared.

False aneurysm of the common digital artery. Is reconstruction with an arterial graft worth the efforts? A case report

False aneurysms in the hand are rare. A false aneurysm of the common digital artery in the palm for the second and third finger is reported, illustrating our experience with arterial graft reconstruction after excision as a valid alternative surgical therapy to a vein graft, when ligation or end-to-end anastomosis are not indicated or feasible. The superficial palmar branch of the radial artery was chosen as donor vessel based on the similarity in vessel diameter and wall thickness to the common digital arteries. Ease of harvesting and performing the microvascular anastomosis using an arterial graft allows for a viable reconstruction after false aneurysm excision in the palm.

Use of superficial palmar arch for bridging the gap in digital revascularisation

Traumatic hand injuries resulting in segmental loss of common digital artery are not uncommon. To bridge the gap and repair of transected common digital artery, the superficial palmar arch could be divided proximally on radial side and turned distally to the common digital artery for revascularisation. Revascularisation of the transversely crushed common digital artery can be performed based solely on superficial palmar arch for revascularisation of the segmental loss of common digital artery. However, because of known variability in the palmar arch, intraoperative verification is needed to ensure safe transfer of arch.

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

Traumatic hand amputations along a longitudinal axis are possible but, to the authors' knowledge, have not been described in the literature. To bridge the gap and repair the transected superficial palmar arch at its apex, a common digital artery can be sacrificed and turned toward the plane of the arch. An anatomical study was performed to investigate the possibility of using the common digital artery to the third web space for completion of the superficial palmar arch. Fifteen fresh cadaveric hands were dissected to evaluate the caliber and origin of the common digital artery to the third web space for possible reconstitution of the arch. In all specimens, a complete superficial palmar arch was identified. In 10 specimens, the superficial palmar arch caliber tapered off from the ulnar to the radial aspect, indicating an anatomical ulnar dominance of the arch. The average diameter of the common digital artery to the third web space was 1.7±0.2 mm. The average superficial palmar arch diameter measured 1.6±0.7 mm on the radial side of the common digital artery. In two female cadaver specimens, a unique pattern in the origin of the common digital artery was identified. The common digital artery to the second and third web spaces originated from a common branch off of the superficial palmar arch. Replantation of a longitudinally amputated hand can be performed based solely on a common digital artery for reconstitution of palmar arch flow. However, because of known variability in the palmar arch configuration, intraoperative clamping must be used to ensure safe use of the donor vessels while avoiding distal ischemic risk.

Penetration of the Digital Nerves by the Common Palmar Digital Arteries in Human Cadavers

To investigate the incidence of digital nerve loop penetration by digital arteries (neural loops) in cadaver palms and to classify these neural loops according to their topography and morphology. In total, 121 palms (from 57 right and 64 left hands) were dissected from 70 preserved cadavers (50 male and 20 female; mean age 66.1 y). Of the 121 palms, 98 had neural loops; 184 cases of neural loop were observed in total. The neural loops could be classified into 4 topographical types, according to their position relative to the digital arteries: ulnar (in which the ulnar proper palmar digital nerve of the finger is penetrated), radial (in which the radial proper palmar digital nerve of the finger is penetrated), common (in which the common palmar digital nerve of the finger is penetrated), and bridge (in which the neural loop is formed by connecting the ulnar and radial proper palmar digital nerves). The neural loops were also classified morphologically according to their size: form A (≥10 mm), form B (4.0-9.9 mm), and form C (≤3.9 mm). The mean lengths in these groups were 16.1, 7.2, and 3.0 mm, respectively, and the overall mean length of all neural loops was 10.8 mm. It was confirmed that neural loops are a common occurrence in humans; hence, it is surprising that it is a little-known variation in the palm.

Primary repair of degloving injury of the distal fingers with nail bed defect

Objective To introduce the operative methods of digital artery island flap with additional fascia flap combining split-thickness nail bed graft for repair of degloving injury of the distal finger, and evaluate the treatment outcomes. Methods From June 2005 to October 2008, three types of digital artery island flap with additional fascia flap combining split-thickness nail bed graft were clinically applied to repair degloving injury of the distal finger in 9 cases. The reversed island flap from the proximal phalanx of the same finger was applied in 6 cases. The forward island flap from the middle phalanx of the adjacent finger was applied in 2 cases, while the reversed island flap from the adjacent finger with ligation of the common digital artery was applied in 1 case.Nail bed grafts were taken from the great toe in 7 cases, the second toe in 1 case, and the avulsed nail bed in 1 case. Results All flaps and nail bed grafts survived. Postoperative follow-up period ranged from 3 months to 2 years. The appearance of the repaired pulps were well-stacked, with 2-PD recovered to 6 to 12 mm. The newly grown nail was flat and smooth, with complete coverage in 3 cases. In 2 cases coverage of the nail bed by the newly grown nail surpassed 4/5, while the coverage was over 1/2 in another 3 cases. All these newly grown nails attached to the nail bed closely. There was only 1 case that had incomplete nail. The range of motion of the distal interphalangeal joint was 30° to 60°. The nail of donor toe grew well, and the function of walking was normal.Conclusion Digital artery island flap with additional fascia flap combining split-thickness nail bed graft is good method in repair of degloving injury of the distal finger. Key words: Surgical flaps; Fingers; Reconstructive; Surgical procedures,operative; Degloving injury

The Versatile Adani′s Flap for Fingertip Coverage

Heterodigital pedicle flaps have 2 possible patters of vascularization: anterograde flow (Littler) or reverse flow (Adani). The Adani's flap uses the Y-V pedicle lengthening principle. The flap is raised from the adjacent uninjured finger based on the digital artery. The common digital artery is ligated and a long pedicle is formed from the 2 converging digital arteries to supply a reverse flow flap. Four patients with severe fingertips injuries were submitted to surgical treatment with the Adani's flap. All flaps integrated and provided skin coverage. The Adani's flap has a long vascular pedicle that allows a wide arch of transposition. An easier vascular dissection in a site distant from the trauma which evolves a higher diameter digital artery and proximal interphalangeal arterial system promotes a high survival rate and good functional results. Adani's flap is a reliable technique for severe fingertip injuries.