A morphometric study on the superficial palmar arch of the hand

Abstract

The vascular anatomy of the hand is a complex and challenging area and has been the subject of many studies. Knowledge of the vascular patterns and diameters of the hand gained more importance with improvements in microsurgical techniques in reconstructive hand surgery. We evaluated 50 hands (26 left, 24 right) of 26 formalin preserved cadavers to determine the superficial palmar arch, its branches and contributing vessels with special attention to the diameters. The symmetry of the types was also evaluated in detail for the first time in the literature. Measurements were made with the help of a digital caliper. The diameters of the ulnar, radial and median arteries were taken at the level of the wrist while the common palmar digital arteries, hypothenar branches and the superficial palmar branch of the radial artery were measured at their origin. Two types of superficial palmar arch were found and defined as complete (43/50 hands) and incomplete arches (7/50 hands). The complete arches were divided into four subgroups and incomplete arches into three subgroups. Most cases were found at the complete AI group (17 hands). Comparison of the arterial diameters showed the ulnar artery was the dominant vessel of the palm. The diameters of the common palmar digital arteries were not different with regard to complete or incomplete arches and between both sides. It looks safe to sacrifice one of the radial or ulnar arteries in some arterial interventions including radial artery cannulation, radial forearm flap and radial or ulnar artery harvesting for bypass grafting if the arch is complete. But we still recommend the noninvasive tests like modified Allen test or Doppler ultrasonography, before performing an invasive arterial intervention. We propose the radiologists to incorporate the median artery into the Doppler dynamic test in particular the existence or the absence of anastomoses between radial and ulnar arteries.

An anatomical investigation of the superficial and deep palmar arches

“…The incomplete arch was observed in 8% of specimens and classified into three types: Type D, Type E, Type F, depending on the branching pattern of the common palmar digital arteries and the proper palmar digital artery to the little finger. These results agreed with Loukas et al [10] (10%) and Bilge et al [4] (14%).…”

“…The complete arches were encountered in 92% of specimens and included arches formed by the ulnar artery alone reaching the space between the thumb and the index finger agreeing with the findings of Loukas et al [10] (90%) and Bilge et al [4] (86%). In the ulnar predominant arches, the ulnar artery gave origin to the common palmar digital arteries as well as the arteria princeps pollicis and arteria radialis indicis which are typically branches of the radial artery that supply the thumb, therefore providing adequate arterial supply to the palm in the absence of the superficial palmar branch of the radial artery.…”

“…The complete SPA observed in this study was divided into three types. The standard classification describing the SPA as completed by the anastomosis of the superficial palmar branch of the radial artery with the ulnar artery has been reported to be evident in as many as 62% of specimens in a study by Bilge et al [4] or as few as 10% of specimens according to the study by Ruengsakulrach et al [15]. The present study observed the standard classification in 44% of specimens and was classified as Type A correlating with Loukas et al [10] 40% in their type S-I classification of the SPA.…”

“…With advances in microsurgical techniques, knowledge of the frequency of vascular patterns, formation and branching of the palmar arches is essential for reconstructive hand surgery [2,4].…”

Vascular anatomy of the thenar eminence: its relevance to a pedicled or free thenar flap

“…Many authors and standard anatomical textbooks have dealt with the vasculature of the hand [3,11,12,15,17]. Only a few articles have been devoted to the cutaneous blood supply of the thenar eminence itself [4,13,16], and there are only scarce data available on the clinical importance of the collateral branches of the radial artery (RA) within the A. Zekavica et al, Arteries of the thenar eminence anatomical snuff-box [7,9,18].…”