Superficial Palmar Branch Research Articles

Clinical application of the free superficial palmar branch of radial artery flap for soft-tissue reconstruction of distal digital injury

PurposeThe purpose of this study is to retrospect and summarize clinical efficiency and experience of the free superficial palmar branch of radial artery (SPBRA) flap for soft-tissue reconstruction in distal digital injury.Method13 patients with soft-tissue defect of finger, reconstructed by the free superficial palmar branch of radial artery (SPBRA) flap in our department from January 2020 to January 2022, were reviewed. After 6–12 months of follow-up, evaluated the treatment effect of the fingers reconstructed by SPBRA flap.ResultsAll the flaps in our series application were survival uneventful, and all the donor sites were closed primarily without complications or obvious scarring. The flaps were soft in texture and satisfactory in appearance and function. The flaps with the median nerve palmar cutaneous branch had a good sensation recovery. Measurement of two-point discrimination (TPD) ranged from 6 to 10 mm. All patients were satisfied with the aesthetic appearance. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, the results were graded as excellent in 11 cases and good in 2 cases.ConclusionThe SPBRA perforator flap has the advantages of simple operation, soft texture, good appearance and function, and is credible and useful for reconstructing various finger injuries.

Digital skin defect management: Hand and wrist volar flap solutions

BackgroundSelecting the optimal flap for managing digit skin defects is challenging, particularly for inexperienced surgeons, given the numerous reconstructive options and insufficient evidence supporting one flap type's superiority over another. This retrospective study introduces four efficacious hand flaps to address volar skin defects and transverse and oblique cuts, examines the optimal flap advancement distance, and discusses effective management. MethodsPatients with digit skin defects who underwent flap surgery between 2009 and 2022 were included. Fifty-four patients treated with oblique triangular, volar VY advancement (unilateral and bilateral pedicled volar VY advancement flaps for fingers and thumbs, respectively), reverse homodigital island, and radial artery superficial palmar branch flaps were included. We evaluated the flap advancement distance, flap length, range of motion, complications, and Semmes–Weinstein monofilament test and Disabilities of the Arm, Shoulder, and Hand questionnaire results. ResultsThe median flap advancement distances for triangular oblique (19 patients), unilateral (11 patients), and bilateral pedicled (5 patients) volar VY advancement flaps were 1.3, 1.8, and 2.0 cm, respectively. The flap lengths for the reverse digital island (8 patients) and radial artery superficial palmar branch (11 patients) flaps were 2.4 and 5.0 cm, respectively. Five, three, and one cases of proximal interphalangeal flexion contractures of ≥ -20° were observed in the VY advancement, reverse digital island, and radial artery superficial palmar branch flaps, respectively. One unilateral VY advancement flap case caused severe numbness and neuroma. All complication cases featured >15 and > 20 mm defect lengths on the fingers and thumb, respectively. ConclusionsTo minimize sensory disruption and contractures, we recommend oblique triangular and unilateral pedicle volar VY advancement flaps for finger skin defects up to 12 mm and defects sized 12–15 mm, respectively. Advancement flaps are unsuitable for >15 and > 20–25 mm defects on the fingers and thumb, respectively.

Comparison of Dorsoulnar Artery Perforator, Superficial Palmar Branch of the Radial Artery, and Superficial Circumflex Iliac Artery Perforator Flaps in Volar Finger Defects.

Volar finger defects can sometimes be challenging for plastic surgeons. There are many reconstruction options from local flaps to free flaps. Therefore, the aim of this study was to present a functional and cosmetic comparison of the results of using dorsoulnar artery perforator (DUAP), superficial palmar branch of the radial artery (SPBRA), and superficial circumflex iliac artery perforator (SCIP) flaps for repairing volar finger defects. Thirty-two patients were included in the study. The age and sex of the patients, cause of injury, defect location, defect size, and presence or absence of nerve damage were noted. The patients' defects were reconstructed with DUAP, SCIP, or SPBRA flaps. The flap size, flap elevation time, vessels, and early postoperative complications were noted. During the postoperative follow-up period, the Michigan Hand Outcomes Questionnaire scale was used to evaluate hand function, and the modified Vancouver Scar Scale was used to assess aesthetic appearance. Two-point discrimination tests and cold intolerance tests were performed to measure sensory outcomes. Donor site improvements were also noted. There was no significant difference between the groups in terms of age, defect size, flap size, follow-up time, and 2-point discrimination. It was observed that the elevation time was significantly shorter in the SCIP flap group, and the Michigan Hand Outcomes Questionnaire score was significantly lower in the DUAP flap group compared with the other 2 groups (P < 0.01). In addition, the modified Vancouver Scar Scale score was significantly higher in the DUAP flap group (P < 0.01). The findings of this study show that the use of SPBRA flaps has more advantages than the use of DUAP and SCIP flaps in many respects.

Finger defect reconstruction using the radial artery superficial palmar branch free flap

Purpose: The radial artery superficial palmar branch (RASP) free flap is accepted as a surgical technique for the reconstruction of finger defects. This study revisited the RASP free flap and evaluated its reliability and usefulness in a variety of finger defects. Methods: From January 2017 to December 2022, multiple surgeons at a single institution performed a total of 315 RASP free flap reconstructions. Basic patient demographics and information on the finger defect and flap were assessed, and immediate postoperative flap and donor site-related complications were also studied. Data regarding long-term outcomes, such as the thumb joint range of motion and static two-point discrimination (S2PD), were collected and evaluated to identify statistically significant differences from the unaffected or non-innervated side. Results: The mean postoperative follow-up was 14.8 months. The total flap survival rate was approximately 91.4%. There was no statistically significant difference in mean postoperative palmar abduction and radial abduction between the affected and unaffected thumbs in both groups. In the single-digit group, there was a statistically significant difference in S2PD between the innervated flap and unaffected side. A statistically significant difference was also found between innervated and non-innervated flaps in the multiple-digits group. Conclusion: The RASP free flap is a valuable surgical option in reconstructing finger defects. It has already been proven to be safe and useful in coverage of single and tip defects. Stability should be ensured when there are multiple defects. Finally, the donor site morbidity is minimal and the recovery of sensation, once the flap is reinnervated, could be promising.

Dual intravascular stent flipping technique for microvascular anastomosis

The anastomosis of vessels <0.5mm in diameter is challenging. We developed a supermicrosurgical anastomosis technique, the dual intravascular stent flipping technique with a double or single clip (dual flipping technique, double-clip technique, and single-clip technique). In the dual flipping technique, we used a 7-0 nylon intravascular stent and clipped the vessel along with the nylon. The double-clip technique was performed in 10 rats with 20 saphenous and 15 superficial inferior epigastric arteries. Immediate and 1-week patency rates were assessed. Subsequently, we examined ten epigastric arteries in five rats with the single-clip technique. The clinical application was performed in six cases involving finger/fingertip amputations, two cases involving radial artery superficial palmar branch flap, and one case involving superficial circumflex iliac artery perforator flap. Using the double-clip technique, the immediate patency rate was 90% and 93% in the saphenous and superficial epigastric arteries, respectively, whereas the 1-week patency rate was 81%. With the single-clip technique, the immediate patency rate was 100%. The replantation and flaps were successful. The advantages of the dual flipping technique included easy insertion, rare slipping-out possibility, and spontaneous vessel dilation by the flipped nylon. Additionally, the posterior vessel wall could be sutured more easily than could the anterior wall. By using the elasticity of the thread to invert the blood vessel, the posterior wall can be sutured without the double clip. When forceps tip insertion into the lumen is difficult, the dual flipping technique enables a relatively easy anastomosis if the 7-0 nylon is inserted into the vessel lumen.

Variations in Superficial Palmar Arch: Case Series with Clinico-anatomical Perspective.

The superficial palmar arch (SPA) is an important anastomotic network primarily formed by the superficial branch of the ulnar artery with one of the superficial branches of the radial artery. SPA variations were observed in three out of 20 cadaveric hand specimens. Two cases of unilateral incomplete SPA and the third case of a unilateral ulnar-to-median complete SPA were recorded. The incomplete SPA was located superficial to the flexor digitorum tendons and deep to the palmar aponeurosis. SPA in the remaining 17 hands was anatomically normal, with major contributions from the superficial palmar branch of the ulnar artery and minor contributions from the superficial palmar branch of the radial artery. These variations are clinically important, especially during procedures like arterial blood sampling, cardiac catheterization, and hemodialysis. Thus, anatomical variabilities in this region may cause complications with vascular occlusion if not ascertained before the procedure.

Proximal bifurcation of the superficial palmar branch of the radial artery and anomalous superficial course of the distal radial artery: a case report

Variations of the radial artery are rare, but clinically significant for surgeons when raising a radial forearm free flap. A 68-year-old man presented with an anomaly of the radial artery, which had a proximal bifurcation of the superficial palmar branch and an anomalous superficial course of the distal radial artery, mimicking duplication of the radial artery. A bifurcation of the main vessel was detected approximately 7 cm proximal to the wrist crease. Anastomosis was performed by using the superficial palmar branch of the radial artery. After anastomosis, the anomalously bifurcated deep palmar branch of the radial artery was transected 1 cm distal to the bifurcation. Although variations, such as unusual bifurcations of the radial artery, are extremely rare, surgeons should be aware of possible variations to ensure safe flap harvesting.

Video recording of hand surgeries using a field of view (FOV) matching USB camera module and smartphone in the era of COVID-19.

As the online medium has gained in popularity due to the recent coronavirus disease (COVID-19) pandemic, video recording of surgical procedures has become crucial in medical education. Various methods for recording are available but many require professional equipment and experienced personnel. Here, we propose a feasible and acceptable method for video recording of surgeries. An M12 mount USB camera, which is based on an Android micro-USB, was utilized. The device was purchased from a website for $32-$40. The camera was mounted between the eyes of the binocular loupes. Surgical procedures were recorded with the camera. The optimal settings were determined according to the types of surgeries. We recorded the following surgical procedures: radial artery superficial palmar branch (RASP) free flap harvest, carpal tunnel release, and free flap operation. The default values were retained for all settings, but the highest image quality (1080 p) was selected with an 8 mm lens. The camera battery was sufficient to record each surgery in its entirety. The USB camera produced high-quality videos that perfectly matched the surgeon's field of view without the need for additional staff for recording. This low-cost equipment could be widely employed for the recording of educational videos for surgeons, especially in the era of COVID 19.

Multidetector-Row Computed Tomographic Analysis of the Superficial Palmar Branch of Radial Artery Perforator Flaps.

Soft-tissue defects in the hand and digits can be effectively covered by using the free superficial palmar branch of the radial artery (SPBRA) flap, which is harvested from the radial volar wrist. Because previous anatomical studies on this flap are limited, multidetector-row computed tomographic angiography of the upper limbs was conducted to characterize the three-dimensional anatomical structure of the SPBRA and its perforators in living patients. This retrospective anatomical study was conducted from 2014 to 2019. All data from Digital Imaging and Communications in Medicine were analyzed by using their viewer. SPBRA diameter and the location where it bifurcated from the radial artery were recorded, as were the number, location, branching patterns, and diameters of its perforators and their lengths. In total, 30 patients met all eligibility criteria. All had the SPBRA. The vessel bifurcated from the radial artery on average 13.2 mm proximally from the radial styloid process. The 30 patients had 40 SPBRA perforators in total. Their average SPBRA-to-dermis length was 6.43 mm. All patients had at least one direct cutaneous perforator. Nine and one also had one musculocutaneous perforator and another direct perforator, respectively. All direct cutaneous perforators were located inside a 16.4-mm-diameter circle with an origin on the scaphoid tubercle. The mean diameters of the SPBRA and its perforators were 1.12 and 0.62 mm, respectively. All patients had at least one reliable SPBRA perforator in the radial volar wrist. The authors' results suggest that plastic surgeons can easily and safely plan the SPBRA flap design, potentially without preoperative perforator mapping.

A Rare Anatomic Variant of the Superficial Palmar Branch of the Radial Artery Used for Arteriovenous Fistula Creation

Anatomical knowledge regarding the variant branching patterns of the radial artery is considerably crucial for interventionalists, vascular, and plastic surgeons. We report a case of a rare variant branching pattern where the superficial palmar branch of the radial artery originated from the radial artery in the forearm instead of the wrist with a subcutaneous course in a 52-year-old patient with diabetic end-stage kidney disease who required haemodialysis initiation. This variant branch was used as inflow for the creation of the arteriovenous fistula for haemodialysis access.

Facilitated harvesting of a radial artery superficial palmar branch flap for reconstruction of moderate finger skin defects

Radial artery superficial palmar branch harvesting is technically challenging, especially for inexperienced hand surgeons. The short pedicle and a damaged recipient digital artery require proximal digital artery dissection and relatively long pedicles. Herein, we describe a facilitated flap elevation technique and its application in various cases. From 2013 to 2021, 10 patients with finger injuries received radial artery superficial palmar flaps. We assessed flap survival, sizes, complications, two-point discrimination, and the Semmes-Weinstein monofilament test results. The main shortcoming of a radial artery superficial palmar flap is its short pedicle. Therefore, we developed a long skin flap design in the long axis direction, and the accompanying vein was dissected proximally to the radial artery to obtain a long pedicle. All flaps survived. The median flap dimension was 5.0×2.2cm (maximum size: 6.0×2.0+5.0×2.0cm [for a bilobed flap]). While nerve reconstruction was performed in one patient, all patients had preserved sensation. A sufficiently long pedicle can be obtained by dissecting the accompanying vein proximally to the radial artery. Perforators found in the skin around the scaphoid tubercle in all cases suggest value in including this region in flap design. To obtain a longer pedicle, the flap was developed with the long-skin design in the long-axis direction. Although the accompanying vein is usually thin and difficult to anastomose with the finger vein, its proximal dissection led to the accompanying vein of the radial artery that facilitated the harvesting of a sufficiently long vein.

Study of contributing arteries to superficial palmar arch formation

The superficial palmar arch (SPA) is formed predominantly by the ulnar artery with a contribution from the superficial palmar branch of the radial artery.: To study contributing arteries in superficial palmar arch formation and variations in its formation.: Study comprised of 30 upper limbs from 15 cadavers. Palmar arches in them were dissected following classical incisions and dissection procedures of Cunninghams’ manual.: SPA was formed by superficial branch of ulnar artery only in 13.33% specimens, by superficial branch of both ulnar and radial artery in 70% specimens, by superficial branch of ulnar and persistent median artery in 13.33% specimens and was formed by superficial branches of ulnar and radial arteries with persistent median artery in 3.33% specimens. SPA was complete in 80% and was incomplete in 20% specimens.: The arch formation is highly variable. Knowledge of contribution to the SPA will be helpful to the reconstructive hand surgical procedures such as arterial repairs, vascular graft applications and re-implantations.

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

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.

Response to letter from Dr M. D. O'Brien.

Dear Sir, We are grateful to Dr O’Brien for highlighting the anatomy of the median nerve and its superficial palmar sensory branch. We agree that, based on anatomy alone, one would expect the palm to be unaffected in carpal tunnel syndrome (CTS), but the functional distinction between the palmar branch and the median nerve itself may not be as great as the anatomy suggests. Dr O’Brien highlights the anomaly of carpal tunnel decompression improving symptoms that would appear anatomically to be related to a more proximal lesion. We quoted work demonstrating glove distribution of symptoms in 35% of cases of CTS. Nora et al. [1] found that among patients with neurophysiological CTS, 44.4% had palmar pain and 62.2% had palmar paraesthesiae. Clark et al. found 39% prevalence of little finger symptoms in cases of CTS diagnosed by hand diagrams, neurophysiology and monofilaments [2]. A further confusion...

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.&#x0D; 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.&#x0D; 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&lt;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&lt;0.05).&#x0D; 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.

Morphological characteristics of autopodium arteries of reindeer' thoracic limb

In the far north, reindeer breeding is a popular direction in the development of agriculture, so veterinarians often treat limb diseases in reindeer. The aim of the study was to research the clinical and morphological characteristics and also development of arterial vessels of the distal links of the thoracic limb. 18 reindeer carcasses of different age groups from the northern mountain-taiga zone of Yakutia were studied. The area of the metacarpus includes four arterial highways: III on the palmar and one on the dorsal surface. Palmar metacarpal arteries: palmar branch (superficially under the skin and common fascia); palmar superficial II metacarpal artery (deeper along the medial edge of the interosseous muscle); palmar deep III metacarpal artery (deep trunk). The arterial highway of the finger of the hand begins from the superficial palmar branch and divides in the distal III of the metacarpus into III vessels: the common palmar finger II, III and IV arteries. The common palmar finger III artery is divided into II annular branches: the axial proper III and IV palmar finger arteries. The arteries of the lateral II and V fingers start from the common palmar finger II and IV arteries. The distal III of the metacarpus includes the superficial and deep palmar arterial arches. The superficial palmar branch and the palmar superficial II metacarpal artery form the superficial palmar arterial arch. The palmar deep III metacarpal artery, the metacarpal feeding artery, and the perforating distal metacarpal artery form a deep arc. The main arteries of the hand grow unevenly. In the postnatal period, the length and diameter of the arteries increased by 1.5-2.2 times (hand arteries – 1.7-2), to 12 months in length 87.1% and diameter of the arteries 89,3% regarding adults (hand arteries represent 89.3% and 85.3%). By the age of 3.5 years, the vessels become the longest, the diameter and wall thickness continue to grow slightly. The growth rates of the length and diameter of the metacarpal arteries during postnatal ontogenesis are similar to age-related changes in the autopodium vessels. Topographic visualization of arterial structures is used for effective therapeutic and diagnostic manipulations, surgical operations of the thoracic limb in reindeer.

Anatomical variations of the superficial palmar arch and its clinical relevance

Background/Aim. In-depth knowledge of the vascular net-work of the hand is of great importance in modern medicine. The main vessel of the hand is the superficial palmar arch (SPA). As typically described in anatomical textbooks, it arises as a terminal branch of the ulnar artery, which then anastomoses with the superficial palmar branch of the radial artery. However, the SPA is characterized by remarkable variability, which has been the area of interest of many researchers so far. The aim of this study was to exert a comprehensive examination of the anatomy of the SPA. Methods. The research was conducted at the Institute of Anatomy ?Niko Miljanic? on a total number of 14 cadavers. After careful dissection, variations of the modality of formation of the SPA and its distance of the SPA 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 &lt; 0.05. Results. According to Coleman and Anson?s classification, the higher incidence of the incomplete type (57.14%) of the SPA was observed compared to the complete type (42.86%). In addition to this, a statistically significant difference was discovered in the distance of the SPA from Kaplan?s cardinal line between two groups with complete and incomplete types, respectively. The parameter examined in the group with the complete type took the value of 2.13 ? 0.32 cm, while in the group with the incomplete type measured 3.33 ? 0.87 cm. Conclusion. The present study showed a very important complexity in the domain of anatomy of the SPA 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.

Observation of the Absence of Ulnar Artery in a Patient Planned to Free Dorsoulnar Artery Perforator Flap for Finger Defect: Is Preoperative Doppler evaluation of Perforator Alone Sufficient?

Abstract Background Volar finger defects where critical structures exposed are always challenging for plastic surgeons. In these types of defects, local flaps, cross finger flaps, abdominal flaps, and free flaps are used. Free dorsoulnar artery perforator (DUAP) flaps and superficial palmar branch of radial artery (SPBRA) flaps are also used. In this case, we present a patient who was scheduled to receive a DUAP flap to address defect on the second finger of right hand; however, we repaired the defect with a SPBRA flap because intraoperative absence of the ulnar artery was observed. Materials and Methods A 34-year-old male patient was admitted with a wound that exposed the tendon and neurovascular bundle on the volar side of the second finger of the right hand. A free DUAP flap was planned for the patient. A perforator was detected during the preoperative Doppler ultrasound examination. While dissecting the perforator, we noted the absence of an ulnar artery proximal to the perforator vessel. The elevated SPBRA flap from same extremity and the defect were closed. Results Postoperative computer tomography showed an absence of the ulnar artery distal to the right antecubital region. No complications were seen in the donor and recipient areas. Long-term motor movements were natural, and the patient's quality of life was good. Conclusion Determining the perforator site using Doppler alone may not be sufficient in preoperative evaluation of patients scheduled to receive DUAP flaps. Performing an Allen test and using advanced imaging methods can prevent surgeons from encountering a bad surprise.

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.

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

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.