Ulnar Artery Research Articles

Evaluation of the incidence of radial artery occlusion using different introducer sheaths and hemostasis techniques.

Radial artery occlusion (RAO) remains one of the most important complications of transradial access (TRA). Despite the identification of multiple predictors, the interaction between these predictors on the occurrence of RAO has not been evaluated. Consecutive patients undergoing TRA coronary angiography (CA) or percutaneous coronary intervention (PCI), were retrospectively analyzed to compare the effect of standard patent hemostasis using a one-bladder band versus two-bladder band with simultaneous ipsilateral ulnar artery compression and two introducer sizes on the primary endpoint of RAO. Access was obtained using 6-Frslender introducer sheath or 7-Frslender introducer sheath and hemostasis with either a one-bladder band or a two-bladder band. The radial artery was evaluated using ultrasound. Total of 2019patients undergoing CA or PCI were included in the analysis. In the one-bladder band group, the incidence of RAO with a 6-Frslender introducer sheath was 4.2%. In those receiving hemostasis with a two-bladder band, RAO occurred in 1% of patients receiving a 6-Frslender introducer sheath versus0.9% in those receiving a 7-Frslender introducer sheath (p = 0.68). Larger radial artery diameter, larger body weight, and a two-bladder hemostasis band with ipsilateral ulnar compression were independently associated with a lower incidence of RAO. A two-bladder band with simultaneous ipsilateral ulnar artery compression when used for radial artery hemostasis, is associated with a lower incidence of RAO, and can mitigate the penalty for a larger catheter with reassuring implications for use of a 7-Frcapable system for complex transradial PCI.

Comparing the Effectiveness and Image Quality of Musculoskeletal Ultrasound of First-Year Medical Students After Training by Student Tutors Versus Ultrasound Instructors: A Pilot Study

BackgroundUltrasound is a vital part in many medical schools’ curriculum. Although there is strong support for the use of student tutors (STs), there is a lack in gauging their effectiveness with more difficult organ systems such as the musculoskeletal (MSK) system. We aim to determine the effectiveness of using STs versus expert ultrasound instructors (UIs) when teaching MSK ultrasound.MethodologyMedical students were recruited to participate in an MSK workshop to identify superficial volar arm structures (radial nerve, radial artery, median nerve, ulnar artery, ulnar nerve) using Butterfly iQ. In total, 14 participants were taught by STs and 10 participants were taught by UIs. Participants imaged the five structures and answered surveys gauging their confidence via five-point Likert scales.ResultsThere was no significant difference in confidence or identification accuracy for all five structures between the two groups. However, there was a significant difference in confidence in the understanding of basic ultrasound concepts in favor of the UI group (p < 0.05). A greater number of students were more confident in identifying all five structures when taught by STs, but more students correctly identified the structures when taught by UIs.ConclusionsThe results on confidence could be due to positive peer perception. Both groups scored relatively high in their identification accuracies, promoting the successful use of STs. The successful use of STs in teaching MSK ultrasound opens the possibility to developing peer-led ultrasound curriculum on more complex ultrasound topics in the future.

“Posterior interosseus artery flap for hand reconstruction: anatomical basis and clinical application”

SummaryFlap options for upper limb reconstruction have increased due to better understanding of its vascular anatomy. The posterior interosseus artery flap (PIAF) is used to cover defects of the wrist, hand, proximal thumb, and first web space. This flap has many advantages but requires good knowledge about the anatomy of the posterior interosseus artery (PIOA) and its perforators.MethodsTwenty upper extremity cadaveric specimens were injected with red latex, Fine dissection of the PIOA and its perforators took place; the perforators were counted, measured, described and photographed.Twenty patients with dorsal hand defects, had PIAF. Cases have Post-operative care and followed up for 6 months post-operative.ResultsThe PIOA was constant in all cadaveric dissections and gave off 4–8 septocutaneous perforators along its course between the extensor carpi ulnaris (ECU) and extensor digitorum (EDM) muscles.The mean distance of the distal most perforator in the middle third forearm from the ulnar styloid was 10.39 ± 1.54 cm. The anastomosis between the PIOA and the anterior interosseus artery (AIOA) was there in all specimens.Venous congestion occurred in 10% of the cases and was managed conservatively. Necrosis of the distal third of the flap was inevitable in one case; excellent results were obtained in the other cases 90%.ConclusionsThe posterior interosseus artery flap is an excellent perforator flap for hand reconstruction preserving the ulnar and radial artery; but it has a possible complications such as venous congestion or partial flap necrosis that could be managed conservatively.Level of evidenceII.

Cutaneous perforators of the arm and anatomical landmarks for defining the flap donor sites.

There are few studies searching for possible perforator flap donor sites on the arm. This study aimed to identify the locations of cutaneous perforators of the arm according to anatomical landmarks. Thirteen Thiel-fixed and latex-filled upper extremities of bodies donated to science were used. The distance between the acromion and medial or lateral epicondyle of the humerus was defined as the Y-axis, and the axis that cut the Y-axis perpendicularly through the epicondyles of the humerus was identified as the X-axis. The Y-axis was then divided into three parts Cutaneous arterial perforators were found using surgical dissection. The locations of the perforators were determined according to the defined lines and regions. On the lateral side, there were 6.00 ± 2.08 perforators per arm, of which 56.4% were septocutaneous and 43.6% muscular. In all extremities, with in the distal 1/3 of the lateral arm, there were 1-4 radial collateral artery-based perforators. The mean distance of these perforators to the Y-axis was 1.16 ± 0.53cm. On the medial side, there were 5.05 ± 1.44 perforators per arm, which were all septocutaneous perforators. In 85% of the extremities, within the middle 1/3 of the medial arms, there were 1-2 superior ulnar collateral artery-based perforators. The mean distance of these perforators to the Y-axis was 1.53 ± 0.61cm. There are always perforators from the radial collateral artery with in the distal third of the lateral arm. Within the middle third of the medial arm, it is usually possible to find a perforator from the superior ulnar collateral artery.

Özel Radyografi Bulgusu ile Bilateral Triquetrum Kırığı

A 44-year-old male patient presented to the emergency department with pain in both wrists because of falling. It was learned that both wrists of the patient were in dorsiflexion while falling, and there was no additional injury. The Glasgow coma scale score was 15; vital values were within normal limits. The patient had bilateral wrist tenderness, pain with ulnar deviation, and edema on the dorsal side. In addition, he had pain with palpation of the left snuff box. Examinations of the ulnar and radial nerves and arteries were normal. X-rays showed a triquetrum fracture in the right hand, and a triquetrum and scaphoid fracture in the left hand. While triquetrum fractures were not apparent on anterior-posterior radiographs, they were clearly visible on both lateral radiographs (Figure 1). With a short-arm splint for the right hand and a scaphoid cast for the left hand, the patient recovered without sequelae after 6 weeks of wrist immobilization.&#x0D; Triquetrum fractures are generally classified as dorsal cortex fractures and body fractures. Dorsal cortex fractures are more common and are usually seen as avulsion fractures. They occur with trauma, especially in the form of falling with wrist dorsiflexion. Our patient also fell with the same mechanism. To diagnose triquetrum fractures, lateral and oblique radiographs should be performed in addition to anterior-posterior radiographs. In particular, dorsal cortex fractures may not be visible on the anteroposterior radiograph, while the avulsion fragment is better seen on the lateral radiograph. The appearance of triquetral fractures on the lateral radiograph is called the "pooping duck sign" because of the typical shape it forms with the scaphoid and lunate bone (Figure 2). In our case, although both triquetrum fractures could not be clearly seen on the anterior-posterior radiograph, they were seen more clearly with typical findings on the lateral radiograph. Triquetrum fractures are typical of carpal bone fractures, which can be seen more prominently on lateral radiographs, and knowing the specific finding on the lateral radiograph may help with the diagnosis.

Distal Radius Fracture with Ipsilateral Elbow Dislocation: A Rare but Challenging Injury.

Distal radius fractures are common and account for approximately 14% to 18% of all adult extremity injuries. On rare occasions, ipsilateral elbow dislocation can be observed additionally. However, this can be missed without careful examination, especially in patients experiencing altered mental status. The aim of this study was to analyze the mechanism, level of injury, demographics, and associated injuries in distal radius fracture with ipsilateral elbow dislocation. Between 2012 and 2019, we searched our trauma database for distal radius fracture with ipsilateral elbow dislocation. All patients older than 18 years old were included. Data on demographics, mechanism of injury, level of energy, and subsequent treatment were collected. A total of seven patients were identified. The mean age in this cohort was 68.7 ± 13.3 years old, and the left side was involved in 71.4% of the patients. Females were affected in 85.7% (n = 6/7) of cases, all of whom suffered from low-energy monotrauma at a mean age of 71.5 ± 12.3 years old. One male patient suffered from high-energy trauma (52 years old). Mainly, posterior elbow dislocations were observed (66.7%; n = 4/6). Distal radius fracture patterns, in accordance with the AO classification, included two C2-, two C3-, one C1-, and one B1-type fractures. In the patient suffering from high-energy trauma, the closed distal radius fracture was classified as type C3. Associated injures included open elbow dislocation, ulnar artery rupture, and damage to the flexor digitorum superficialis. Although distal radius fracture with ipsilateral elbow dislocation is thought to be from high-energy trauma, this study shows that most patients were elderly females suffering from low-energy mechanisms. It is important for clinicians to maintain a high level of suspicion for any concomitant injury in this population.

Ulnar and radial arteries perforator-based flaps: a cadaveric study and scoping review with narrative synthesis

Ulnar and radial arteries perforator-based flaps: a cadaveric study and scoping review with narrative synthesis

Prevention of radial artery occlusion by simultaneous ulnar and radial compression (PRO-SURC). A randomized duplex ultrasound follow-up study

BackgroundThere might be a beneficial effect of transient ulnar artery compression in prevention of radial artery occlusion (RAO) after trans-radial catheterization. ObjectiveThe objective of this study was to assess, by Duplex ultrasound, the efficacy of simultaneous ulnar and radial artery compression (SURC), in prevention of RAO, compared to conventional and patent hemostasis techniques. Patients and methodsFour hundred and fifty consecutive patients undergoing elective trans-radial catheterization were enrolled. Patients were randomized in 1:1:1 fashion into 3 groups; conventional hemostasis (Group A, n = 150 patients), patent hemostasis (Group B, n = 150 patients), and SURC technique (Group C, n = 150 patients). RAO was assessed by duplex ultrasound at 1-h post TR band removal (primary endpoint), and at 1-month. ResultsThe primary endpoint, RAO 1-h post TR-band removal, was significantly lower among patients of group C as compared to those of group A and B (1.3%, 6.7%, and 7.3%, respectively –p = 0.03). This was still consistent at 1-month (0.7%, 8%, and 6%, respectively –p = 0.03). Multiple regression analyses revealed that lower radial artery diameter (RAD) after flow-mediated dilatation (FMD) independently predicted RAO at 1-h, while RAD at 1-h post-TR band removal was the only independent predictor of RAO at 1-month. Receiver operator characteristic (ROC) analysis showed that RAD at 1-h post-TR band removal at cut-off ≤1.75 mm could predict RAO at 1-month with high accuracy (AUC = 0.9, CI = 0.8–1.0, p < 0.001–86% sensitivity, and 95% specificity). ConclusionA technique of SURC is associated with less incidence of early and late RAO compared to conventional hemostasis techniques.

Study of Variations in the Course of Brachial Artery: A Cadaveric Study

Background: Brachial artery begins as a continuation of axillary artery at the distal border of teres major, runs downward at first medial to the humerus and then inclines to lie in front of the bone until it appears in the cubital fossa, where it ends at the level of the neck of radius by dividing into radial and ulnar arteries. Objectives: To know the variations in the course of brachial artery. Methods: Dissection was done on 40 upper limbs from embalmed adult human cadavers in the Department of Anatomy, Kamineni Institute of Medical Sciences, Narketpally. Dissection of Brachial artery was carried out according to Cunningham’s manual of practical anatomy. Results: In all 40 specimens (100%), the brachial artery begins at the inferior border of the teres major muscle as the continuation of the axillary artery. In 37 specimens (92.5%), single brachial artery (BA) was present in the arm. It runs inferiorly on the medial side of the biceps brachii muscle to the cubital fossa. It divides into the radial artery (RA) and ulnar artery (UA) opposite the neck of radius at elbow. In 3 specimens (7.5%), doubling of the brachial artery in its course was observed. In these specimens, the brachial artery was divided into two divisions in the arm. Both divisions runs inferiorly on the medial side of the biceps brachii muscle to the cubital fossa. In these two divisions, one lies superficial to the median nerve and was called the superficial brachial artery (SBA) and other division continues as the brachial artery proper (BAP). In all these 3 specimens (7.5%), the superficial brachial artery (SBA) continued as the radial artery (RA) and brachial artery proper (BAP) continued as the ulnar artery (UA) in the cubital fossa. Interpretation and Conclusion: The present study is important for Surgeons, Orthopedicians, Vascular surgeons, Clinicians and Anatomists as it provides the knowledge of variations in the course of brachial artery in the arm and cubital fossa. KEY WORDS: Brachial artery, Superficial brachial artery, Cubital fossa. Radial artery.

Palmaris Longus Inversus Muscle Present Bilaterally in an 82 Year-old White Female Cadaver and Unilaterally in a 68 Year-old White Female Cadaver

The palmaris longus muscle is one of the most variable muscles in the human body. Palmaris longus muscle anatomical variations include reversed (palmaris longus inversus muscle), duplicated, triplicated, bifid, hypertrophied, accessory (additional) slips, and/or complete absence. During anatomical dissection of fifty cadavers in the 2019 undergraduate first-year anatomy course at the Uniformed Services University of the Health Sciences, we found a palmaris longus inversus muscle bilaterally on an 82 year-old White female cadaver and a unilateral palmaris longus inversus muscle on the right forearm of a 68 year-old White female cadaver. Due to the prevalence of anatomical variations in the palmaris longus muscle, adequate knowledge of such prevalence and clinical significance is needed in multiple medical specialties for its reconstructive use, and the possibility and treatment of clinical syndromes. An accessory (additional) palmaris longus muscle, hypertrophied palmaris longus muscle, hypertrophied palmaris longus inversus muscle, or just the presence of a palmaris longus inversus muscle, can all cause compression to adjacent neurovascular structures, such as the median nerve, ulnar nerve, ulnar artery, and/or the anterior interosseous artery, in the distal forearm and wrist. Palmaris longus tendons are used as grafts in various surgeries, such as extensor tendon repair in rheumatoid arthritis patients, injuries of flexor tendons and repair, lip augmentation, reconstructive hand surgery, frontalis suspension sling in ptosis correction, plastic surgery, and pulley reconstructions. Surgeons, physicians, radiologists, and physiotherapists must be knowledgeable of the many PLM anatomical variations and their possible contributions to pathological processes.

A rare case of median nerve intraneural hematoma after stenting of right iliac artery

Aim: Brachial artery access is an alternative approach to endovascular interventions when access to the femoral, radial, or ulnar arteries is not feasible, but it carries higher risk of periprocedural complications than other approaches, including median nerve injury. Nerve injuries can occur by direct puncture or by compression, with hematoma being the most common cause. Sometimes the compartment syndrome can accompany the direct nerve injury, masking the signs of a nerve dysfunction. Case report: We present a patient with a false aneurysm of brachial artery, surrounding soft tissue hematoma with volar arm and forearm compartment syndrome and a simultaneous median nerve intraneural hematoma caused by a direct punction. The combination of injuries occurred after brachial artery access for endovascular treatment of bilateral iliac artery steno-occlusive disease. The patient was successfully treated by fasciotomy, arterial sutures, and nerve decompression via paraneuriotomy. Conclusions: Intraneural hematoma caused by direct puncture can be masked by concomitant compartment syndrome. Emphasis should be put on prevention, early recognition, and timely surgical treatment of intraneural hematomas, especially those accompanied by fascial compartment syndrome after endovascular interventions.

Right Vertebral Artery Arising From Ipsilateral Common Carotid Artery With Severe Stenosis of Ostio-proximal Segment of Aberrant Right Subclavian Artery: A Rare Life-Saving Variant

Anomalous origins of vertebral arteries are rare vascular anomalies that are incidentally identified during computed tomography, magnetic resonance imaging, or digital subtraction angiograms. We present the case of a 45-year-old male who had gangrene of the right ring finger associated with absent radial, ulnar, and brachial artery pulses. A computed tomography angiogram of the upper limb including the arch of aorta showed an aberrant right subclavian artery having near-total stenosis at the origin. An anomalous origin of the right vertebral artery from the right common carotid artery was also noted. This incidental variant anomaly of the vertebral artery was vital in this case as it spared the posterior cerebral circulation from vascular insufficiency complications. It is also important for future head and neck endovascular interventions to avoid inadvertent arterial injury.

Use of Radial Artery Grafts for Coronary Artery Bypass Grafting.

Coronary artery bypass grafting (CABG) is the primary surgical treatment for coronary artery disease (CAD). However, long-term clinical practice has confirmed the poor long-term patency of saphenous vein grafts (SVG), prompting surgeons to investigate alternatives, such as the use of radial artery (RA) grafts. In this report, we review and discuss the current status of radial artery application during CABG and current controversies in the field. Ultimately, evidence indicates that RA-CABG is associated with good long-term patency and is suitable for patients with severe stenosis. However, the compensatory capacity of the ulnar artery should be assessed prior to RA harvesting. Given that the RA is prone to spasms, routine application of calcium channel blockers is recommended. Several studies also have indicated that sequential grafting is an effective method for maximizing radial artery application and that patency rates are similar for the radial artery and right internal mammary artery. In contrast, the use of the bilateral internal mammary arteries is technically more demanding and exhibits a significant volume-outcome relationship. The decision to use the right internal mammary artery or radial artery should be based on individual patient characteristics and the experience of the surgical team.

Neglected Iatrogenic False Aneurysm of the Ulnar Artery

Vascular complications during an ulnar procedure are very rare. However, they must be identified quickly. We repport a case of a 68-year-old hypertensive patient who was admitted to the emergency department for unstable angina, where she underwent coronary angioplasty via the left ulnar route. she was referred to us for management of a pseudoaneurysm on the inside of the wrist facing the ulnar artery one month later.

Open resection for a large iatrogenic radial artery pseudoaneurysm. Case report.

Introduction and importanceWe present the case in which a large symptomatic pseudoaneurysm (PSA), 6 × 5 cm, with one year of evolution on the path of the right radial artery (RRA) appeared after its punction and cannulation for performing cardiac catheterism in an atrial fibrillation (AF) indefinite anticoagulated patient. Diagnosis and surgical planning were consolidated only by using color duplex ultrasound (CDU), contrasted images were not indicated.The open surgical management was performed during a short-time supraclavicular blockade of peripheral nerves without stopping nor bridging anticoagulant therapy. Complete excision of the deforming mass with no blood loss, decompression of the adjacent structures and direct closure of the arterial defect without compromising of its lumen and path were also achieved.Case presentationA 74-year-old, Hispanic male patient and former smoker underwent coronary catheterization for thoracic typical pain. One year after, he is admitted for move restrictive pain in distal right forearm and hand paresthesia related to a rapidly growing right radial artery PSA of 6 cm in diameter where the indefinite anticoagulation, indicated for chronic AF, confers a risk of major bleeding.After clinic and exclusive CDU assessing, the patient granted us written authorization for performing an open surgery.One year follow up showed an asymptomatic patient with no RRA residual lesions.Clinical discussionAlthough contrasted are the preferred diagnosis methods when arterial issues are suspected especially angiography since, when indicated, the endovascular treatment may be performed immediately after diagnosis. The CDU performed with a high-sensitivity transducer is the image of choice for an immediate differential diagnosis (Meola et al., 2021 [1]). In addition, it allowed us to see both, the particular PSA inside structure and the patency of ipsilateral ulnar artery, necessary details to propose the successful open surgical treatment finally conducted.ConclusionVascular and trauma surgeons should be trained to ensure the correct diagnosis based on preexisting medical conditions, clinical findings and those provided by CDU in order to offer an appropriate and definitive management to peripheral vascular iatrogenic lesions with potential bleeding risk, especially in anticoagulated patients. Since large limb deforming PSAs are recommended to be excided through open access, they should also be trained to perform it without additional risks nor sequelae.Since the number of AF patients is increasing worldwide, main aspects on anticoagulation therapy have to be taught to every surgical team.

Cover

The cover image is based on the Research Report Analysis of the radial and ulnar arteries using ultrasound and a vascular visualization device in children by Makoto Kemmochi et al., https://doi.org/10.1111/pan.14434.

"Safe dissection parameters of the anconeus rotational flap for soft tissue coverage at the elbow".

The anconeus is a small muscle located on the posterior elbow originating on the lateral epicondyle and inserting onto the proximal-lateral ulna that functions as an elbow extensor as well as dynamic stabilizer. The blood supply is tri-fold: medial/middle collateral artery (MCA), recurrent posterior interosseous artery (RPIA), and less commonly found, the posterior branch of the radial collateral artery. The anconeus has become a popular option for local soft tissue coverage about the elbow (distal triceps, olecranon, proximal forearm). The average defect size for consideration of local anconeus flap coverage is 5-7cm2. The aim of the study was to determine safe dissection parameters of the anconeus as well as map arterial pedicles to achieve successful local harvest of the muscle without devascularization. 8 fresh frozen cadaveric arms (all male, average age 63 years - 4 left arms, 4 right arms) from scapula to fingertip were obtained. First, the radial, ulnar and axillary arteries were dissected and isolated. The radial and ulnar arteries were transected. 100cc normal saline was injected through the axillary artery, sequentially clamping the radial followed by the ulnar artery so that adequate flow could be seen through all vessels. 100cc mixture of Biodür and hardener (10:1) was mixed and injected into the axillary artery. We first allowed free flow through both the ulnar and radial vessels followed by clamping of these vessels. This allowed the pressure to build up and fill the smaller vessels in the arms. After injection, the axillary artery was then clamped and the specimens were left to harden for 24-48 h. After hardening, dissection was performed by making a curvilinear incision centred over the lateral epicondyle. The anconeus was identified and the interval between the anconeus and ECU was then confirmed. Measurements of the anconeus muscle were taken. Blunt dissection was carried between anconeus and ECU until the RPIA was identified and protected. We isolated the MCA by dissecting proximally. This was found to run with the nerve to the anconeus. Once this vessel had been protected, the muscle reflected from distal to proximal staying along its ulnar border. The branches of the RPIA were ligated and the dissection was continued proximally. Measurements of the distances of the RPIA, MCA were taken. The average distance of olecranon to muscle tip was 95.0mm. The average distance of lateral epicondyle (LE) to muscle tip was 90.8mm. The average distance of LE to olecranon was 49.8mm. The average location of the RPIA was 63.mm when measuring LE to vessel, 68.3mm when measuring olecranon to vessel, 18.3mm when measuring RPIA to muscle tip. The average RPIA diameter was 1.1mm and length was 36.4mm from the initial branching of the posterior interosseous artery. The average MCA diameter was 0.7mm. The posterior branch of the radial collateral artery was only found in 3/8 specimens. The RPIA and MCA were constant in all specimens. Dissection was safely carried to the border of the LE and olecranon without disruption of the MCA. Our conclusions determined that if dissection of the anconeus is undertaken, the RPIA remains constant between the interval of the ECU as well as anconeus at an average distance of 18.3mm from the tip of the muscle measuring proximally; moreover, the MCA was constant in all specimens found directly between the LE and olecranon always running with the nerve to the anconeus. When dissecting and mobilizing to ensure preservation of the MCA, dissection should be taken from distal to proximal as well as dissecting along the ulnar border of the anconeus. Proximal dissection can be taken as proximal as the border of the LE and olecranon as that did not disrupt MCA blood supply.

Case Study: Superficial Ulnar Artery and its Clinical Significance

We present a case with an atypical variation of the ulnar artery discovered while examining a cadaver in our routine Gross Anatomy lab dissection. A superficial ulnar artery was found in a 55‐year‐old male cadaver originating directly from the brachial artery. This is a rare variation where the route of the ulnar artery runs superficially to the flexor compartment in the forearm. Based on previous cadaver studies, the incidence of such variation in the adult population appears to be approximately 3.75% 1. Deviations in the ulnar artery can lead to a potential risk of injury to patients during surgery 2. The superficial ulnar artery can mistakenly result in the administration of medicines into the artery as opposed to the median cubital vein during the injection. Hemorrhaging as well as other potential traumas can occur. We will also discuss the potential complications that could arise from this variant and the clinical recommendations for treatment.1. Fadel RA, Amonoo‐Kuofi HS. The superficial ulnar artery: Development and surgical significance. Clin Anat. 1996;9(2):128‐132. Accessed Jan 27, 2022. doi: 10.1002/(SICI)1098‐2353(1996)9:2&lt;128::AID‐CA5&gt;3.0.CO;2‐D.2. Rodríguez‐Niedenführ M, Vazquez T, Parkin IG, Sanudo J. Arterial patterns of the human upper limb: Update of anatomical variations and embryological development. European Journal of anatomy, ISSN 1136‐4890, Vol 7, Nº 1, 2003 (Ejemplar dedicado a: Supplement 1), pags 21‐28. 2003;7. Accessed Jan 26, 2022.

Frequency, variation, and structure of the median artery in a cadaver sample from New Mexico

The median artery is presently understood to be an embryonic structure, which typically begins to regress around the 8th week of intrauterine life. However, this artery can sometimes persist well into adulthood. It can exist as one of two types, forearm or palmar, which is determined by the site of termination. The purpose of this study was to examine the prevalence of the persistent median artery in a sample size of 41 cadavers from the University of New Mexico School of Medicine Anatomy Lab. Additionally, site of origin and termination were recorded. Out of 82 forearms from 41 cadavers, the persistent median artery was observed in eight (9.75%). Of these, five (62.5%) were determined to be the forearm type and three (37.5%) the palmar type. The artery was present bilaterally in only one case (12.5%). The most common site of origin was the common interosseus artery (5; 62.5%), followed by the ulnar artery (2; 25%), and the anterior interosseus artery (1; 12.5%). The persistent median artery was present in close to 10% of this population, which is a lower prevalence than observed in other similar studies. Presence of the persistent median artery is relevant to health care providers and worth considering due to role it may play in conditions such as carpal tunnel syndrome, as it would reduce the available space inside this pathway.

Palmaris Longus Inversus Muscle Present Bilaterally in an 82‐Year‐old Cadaver and Unilaterally in a 68‐Year‐old Cadaver

The palmaris longus muscle is one of the most variable muscles in the human body. Palmaris longus muscle anatomical variations include reversed (palmaris longus inversus muscle), duplicated, triplicated, bifid, hypertrophied, accessory (additional) slips, and/or complete absence. During anatomical dissection of fifty cadavers in the 2019 undergraduate first‐year anatomy course at the Uniformed Services University of the Health Sciences, we found a palmaris longus inversus muscle bilaterally on an 82‐year‐old white female cadaver and a unilateral palmaris longus inversus muscle on the right forearm of a 68‐year‐old white female cadaver. Due to the prevalence of anatomical variations in the palmaris longus muscle, adequate knowledge of such prevalence and clinical significance is necessary in various medical specialties for its use in reconstructive surgery, and the possibility and treatment of clinical syndromes. An accessory (additional) palmaris longus muscle, hypertrophied palmaris longus muscle, hypertrophied palmaris longus inversus muscle, or just the presence of a palmaris longus inversus muscle, can all cause compression to adjacent neurovascular structures, such as the median nerve, ulnar nerve, ulnar artery, and/or the anterior interosseous artery, in the distal forearm and wrist. Palmaris longus tendons are used as grafts in a variety of surgeries, such as extensor tendon repair in rheumatoid arthritis patients, injuries of flexor tendons and repair, lip augmentation, reconstructive hand surgery, frontalis suspension sling in ptosis correction, plastic surgery, and pulley reconstructions. Surgeons, physicians, radiologists, and physiotherapists must be knowledgeable of the many palmaris longus muscle anatomical variations and their possible contributions to pathological processes.