Anatomic study of the dorsal arterial system of the hand

Abstract

Historically, the dorsal arterial system of the hand received less attention than the palmar system. The studies concerning dorsal arterial anatomy present some controversies regarding the origin and presence of the dorsal metacarpal artery branches. Knowledge of the anatomy of dorsal metacarpal arteries is especially applied in the surgical planning for flaps taken from the dorsum of the hand. The purpose of this study is to analyze the arterial anatomy of the dorsum of the hand, compare our observations with those of previous studies from the literature, and therefore to define parameters for surgical planning for flaps supplied by the dorsal metacarpal arteries.METHOD: Twenty-six dissections were performed at the dorsum of the right hand of 26 cadavers by making a distalbased U-shaped incision. After catheterization of the radial artery at the wrist level, a plastic dye solution with low viscosity and quick solidification was injected to allow adequate exposure of even small vessels. The radial artery and its branches, the dorsal arterial arch, the dorsal metacarpal arteries, the distal and proximal communicating branches of the palmar system, and the distal cutaneous branches were carefully dissected and identified. RESULTS:The distal cutaneous branches originating from the dorsal metacarpal arteries were observed in all cases; these were located an average of 1.2 cm proximal from the metacarpophalangeal joint. The first dorsal metacarpal artery presented in 3 different patterns regarding its course: fascial, subfascial, and mixed. The branching pattern of the radial artery at the first intermetacarpal space was its division into 3 branches. We observed the presence of the dorsal arterial arch arising from the radial artery in 100% of the cases. The distance between the dorsal arterial arch and the branching point of the radial artery was an average of 2 cm. The first and second dorsal metacarpal arteries were visualized in all cases. The third and fourth dorsal metacarpal arteries were visualized in 96.2% and 92.3% of cases, respectively. There was proximal and distal communication between the dorsal arterial arch and the palmar system through the communicating branches contributing to the dorsal metacarpal artery formation.CONCLUSION: At the dorsum of the hand there is a rich arterial net that anastomoses with the palmar arterial system. This anatomical characteristic allows the utilization of the dorsal aspect of the hand as potential donor site for cutaneous flaps.

Measurement of the Flexing Force of the Fingers by a Dynamic Splint With a Dynamometer

“…4 A thorough understanding of the vascular distribution to the hand is also essential. 5 When prescribing the application of an external forceideally controlled and measurable-caution and accuracy are essential, i.e. the necessary torque and the time of application must be calculated, lest ischemia, pain, or other possible injuries ensue.…”

Unusual ending of the second dorsal metacarpal artery as proper palmar digital arteries

“…The 2DMA, founded in high percentages, originates from radial artery [3,[5][6][7][8], dorsal carpal arch [1,5,6,9,10], deep palmar arch [11,12], and anterior interosseous artery [9]. Following the second dorsal interosseous space from these different sources, gives branches to the dorsal skin of the hand, the skin of next fingers, and 2nd metacarpal bone.…”

“…We can design it as a proximal or distal vascularized cutaneous flap [5][6][7][8][9]10,11,17] or as a vascularized bone flap [5,18]. Regardless of flap type, the 2DMA or the distal perforant artery must be ligated [8,10].…”

Treatment of Symptomatic Distal Interphalangeal Joint Arthritis with Percutaneous Arthrodesis: A Novel Technique in Select Patients

“…The vascularity of the DIP region remains a concern. The dorsal skin of the hand is supplied by distal cutaneous branches of the dorsal metacarpal artery that perforate the fascia as they progress distally [4], as well as the dorsal cutaneous branch of the palmar digital artery [19]. Anatomical studies of the DIP joint utilizing MRI imaging have revealed minimal fat in the area of the DIP joint and a dorsal septum that adheres the skin to the extensor tendon at the level of DIP joint [16].…”