Formation Of Superficial Palmar Arch Research Articles

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

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.

A Cadaveric Study of Superficial Palmar Arch with Surgical Importance

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 formation of superficial palmar arch and the arterial pattern of hand were noticed. The variations found were classified according to Coleman and Anson classification. Results: Out of 45 limbs, complete arch was found in 36 limbs and incomplete arch in nine limbs. In complete arch type, we found an arterial arcade, bifurcation of ulnar artery and in incomplete arch type, radial-radial anastomosis. Another rare findings of highly tortuous ulnar artery in forearm and in the palm. Conclusion: The findings in the variations of superficial palmar arch are essential in microvascular surgery, forearm fasciocutaneous flap, radial artery and ulnar artery harvesting in coronary artery bypass graft procedure.

Cadaveric Study of Topographical Location and Arterial Diameter of Superficial Palmar Arch with its Clinical Implication

Background: During the surgical exposure of carpal tunnel, it is possible to injure neurovascular structures, especially the superficial palmar arch (SPA) due to its proximity to the flexor retinaculum. Hence, the topographical location of SPA is necessary to avoid iatrogenic injuries. Size of the vessels forming SPA is important to carry out new procedures in the microsurgical techniques in reconstructive surgeries. Materials and Methods: The present study was conducted on 40 cadaveric hands obtained from AJ Institute of Medical science, Mangalore. The distance between the SPA and distal wrist crease (DWC) and Kaplan's cardinal line (KCL) were measured. Diameters of arteries which are mainly contributing in the formation of SPA and its branches were measured with a digital caliper, and mean and standard deviation were calculated. Results: The distance of SPA, from DWC was 44.22 ± 4.98 mm and from KCL along the lateral and medial border of ring fingers was 8.32 ± 1.01 mm and 9.54 ± 0.95 mm, respectively. The average diameter of the ulnar artery was 2.84 mm; radial artery was 2.79 mm; the superficial palmar branch of the radial artery, princeps pollicis artery, and the median artery was 1.5 mm, 1.24 mm, and 2.025 mm, respectively. Conclusion: The results of the present study on the location of the SPA as well as arterial diameters will be of great help for the surgeons and radiologists. Advances in reconstructive surgeries of the hand, especially microsurgeries has entailed a better understanding of arterial variations, in-depth knowledge of which is necessary for the positive outcome of surgical procedures.

Formation of Superficial palmar arch and its clinical relevance - Cadaveric study

Formation of Superficial palmar arch and its clinical relevance - Cadaveric study

A morphological study of variations in superficial palmar arches of the hand

Objectives: Arterial arches of the hand are very important for orthopedic surgeons as well as microvascular surgeons while doing surgeries on hand. The greatest risk associated with harvesting the radial artery for coronary artery bypass grafting is ischemia of the soft tissues of the hand. There may be numerous variations in the formation of these arterial arches which will be important for the surgeons. So, for the above-mentioned reasons the following study was undertaken to look for the pattern of superficial arches in hands and its variations. Materials and Methods: The study was done on 75 formalin fixed upper limbs from the Department of Anatomy. Incision was given according to Cunningham manual of anatomy and superficial palmar arch was exposed, and its formation from different branches was noted down. The variations were noted down in the formation of superficial palmar arch to provide a database of the normal and variant anatomy. Results: In 77.3% of specimens superficial palmar arch was complete and in 22.6% of specimens it was incomplete. Conclusion: The variations found in this study will help not only the anatomists, but also orthopedics and microvascular surgeons who do surgery on hands. Current progress in the microsurgical procedures for reconstructive hand operations needs the understanding of variant arterial arches, the comprehensive knowledge of which is vital for the surgical interventions and successful outcome of the surgeries.

Formation Of Superficial Palmar Arch:A Cadaveric Study With Its Clinical Significances

The vasculature of the hand has been a topic of anatomical interest because of wide range of variations in the formation and distribution of palmar arches. In the present study we have emphasized on the varying pattern of the formation and branching pattern of the superficial palmar arch (SPA) in cadaveric human hands. The study was conducted in 42 formalin fixed human cadaveric hands and different presentations were noted. The classic formation of the SPA was noted in 76.6% of the specimens and mostly on the right hand. The other variants noted were SPA completed by the first dorsal metacarpal artery and SPA formed between median and ulnar artery. Incomplete SPA ending in the thenar muscles and an abrupt end between the index and middle finger were also noted in the present study. The existence of both common and rare anatomic variations in the formation of superficial palmar arch as well as the absence of collateral circulation between ulnar and radial arteries necessitates the proper knowledge of vasculature of the hand in order to avoid or minimize the risk of complications during vascular surgeries or reconstructive surgeries in the hand.

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.

Median artery in formation of superficial palmar arch: A cadaveric study

BackgroundKnowledge of the variations in the arterial supply of hand has reached a point of practical importance with the advent of microvascular surgery for revascularization, replantation and composite tissue transfers. Superficial palmar arch has many interesting variations, of them the median artery contribution is been evaluated in the present study.Method100 cadaveric hands of 50 cadavers were dissected and their formation and pattern was recorded according to Coleman and Anson classification, 1961 and photographed. The present study highlights particularly the median artery contribution in the formation of superficial palmar arch.ResultsIn the present study 4% of specimens showed medianoulnar type of incomplete superficial palmar arch. This observation had a unilateral presentation seen in only right hand of four adult male cadavers. The left hand of these specimens showed ulnar type of complete arch.The median artery is a transitory vessel that represents the arterial axis of the forearm during early embryonic life. It normally regresses in the second embryonic month Its persistence in the human adult has been recorded in different patterns: as a large, long vessel (palmar type) which reaches the hand is the focus of present study The clinical importance of the persistence of this artery at wrist level is well documented as a cause of the carpal tunnel syndrome, but it has also been associated with the pronator teres syndrome’ in cases where the persistent median artery pierces the median nerve in the proximal third of the forearm.

Superficial palmar arch completion at the first interdigital cleft: a case report

Knowledge of variations in the formation of superficial palmar arch is beneficial for successful vascular surgery in the hand as well as for plastic surgeons. The authors describe an unusual completion of superficial palmar arch by first dorsal metacarpal branch of radial artery at the first interdigital cleft which was encountered during routine upper limb dissection for undergraduates. The arteria princeps pollicis and arteria radialis indicis also were the branches of first dorsal metacarpal artery at the first interdigital cleft.

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.

Palmar Type of Median Artery as a Source of Superficial Palmar Arch: A Cadaveric Study with its Clinical Significance

The superficial palmar arch (SPA) and its contributing arteries are highly variable. The palmar type of median artery (PMA) can be involved in the formation of the SPA by replacing the superficial palmar branch of the radial artery (RA) or the ulnar artery (UA). The present study was undertaken to investigate the presence of the PMA and its contribution in the formation of SPA in 42 cadavers (84 upper limbs) of Indian origin. When there was a PMA, its outer diameter was measured in the carpal tunnel. The PMA was found in 13 upper limbs (15.4%), and of these ten incidences (11.9%), the PMA took part in the formation of SPA, and in three instances (3.5%), the PMA did not make up part of the SPA. Out of the ten cases in which the PMA contributed to the formation of SPA, in six cases (7.1%), the PMA anastomosed with the UA; in three cases (3.5%), the PMA anastomosed with both the UA and the RA, and in one incidence (1.1%), the PMA joined the arteria radialis indicis (deep branch of the RA) to complete the SPA. The outer diameters of the median arteries varied between 0.8 and 2.6 mm with the mean value of 1.7mm. The present study concludes that the median-ulnar type of SPA was the most common type of SPA when the PMA was encountered as a source of superficial arterial arcade of the hand, followed by the radial-median-ulnar type. The vascular patterns found in this study are important to hand surgeons. The present study of PMA origin, course, and its contribution to the SPA will add to the existing knowledge of the vascular anatomy of forearm and hand.

Unorthodox superficial palmar arch observed in a South Indian cadaver: a case report

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.