Surgical implications of variations in hand collateral circulation: Anatomy revisited

Abstract

One of the risks associated with harvesting the radial artery is hand ischemia. Accordingly, this study investigated the variations of the hand collateral circulation.Methods: Fifty hands of cadavers were examined. Variations of the palmar arches were recorded. A classic superficial palmar arch was defined as direct continuity between the ulnar artery and the superficial palmar branch of the radial artery. A classic complete deep palmar arch was defined as direct continuity between the radial artery and the deep branch of the ulnar artery.Results: A classic superficial palmar arch was found in 10% (5/50) of hands, and a classic complete deep palmar arch was found in 90% (45/50) of hands. The superficial palmar branch of the ulnar artery supplied blood to all fingers in 66% (33/50) of hands. Although the superficial palmar branch of the ulnar artery was continuous with the radial artery in only 34% (17/50) of hands (including the classic type of superficial palmar arch), every hand had at least one major branch connecting the radial and ulnar arteries. Conclusions:Variations in the terminations of the radial and ulnar arteries are common. Although the classic type of superficial palmar arch occurs relatively infrequently, there is always a significant anastomosis between the radial and the ulnar artery in the hand. This anatomic study confirms the presence of a collateral supply in the hand. In the absence of vascular disease, harvesting the radial artery should be regarded as a safe procedure.

Functional anconeus free flap for thenar reconstruction: a cadaveric study

“…7 Mean angle of orientation of muscle fibers at quarterly intervals along the long axis of the anconeus muscle and its corresponding abductor pollicis brevis was of a sufficient length and caliber (Table 1) as a free flap pedicle. It would match the diameter of the superficial palmar branch of the radial artery although that is not reliably present [5,9] and so its length and caliber would permit routine use of end-to-side anastomosis with the radial artery. Venous anastomosis would be possible to the venae comitans of either vessel.…”

“…In summary, the anconeus has promising morphological, vascular, and gross motor nerve characteristics that merit its consideration for use as a FFMT in reconstructing select defects of the thenar eminence for which standard reanimation techniques are not applicable. (14) 70 (10) 10/°68 (9) 74 (9) 11/°78 (5) 82 (10) 12/°77 (9) 87 ( …”

An anatomical investigation of the superficial and deep palmar arches

“…The DPA has less variability compared with the SPA [3]. The types of DPA are also classified as either complete or incomplete [15]. A complete DPA occurs when the terminal portion of the deep palmar branch of the radial artery (DPBRA) anastomoses with the DPBUA [15].…”

“…The types of DPA are also classified as either complete or incomplete [15]. A complete DPA occurs when the terminal portion of the deep palmar branch of the radial artery (DPBRA) anastomoses with the DPBUA [15]. An incomplete DPA occurs when the DPBRA has no connection with the DPBUA [15].…”

Pattern of Variations in Superficial Palmar Arch and its Clinical Importance

“…[3] The classic morphology of SPA is defined as direct continuity between the ulnar artery and superficial palmar branch of the radial artery. [4] The Vascular patterns of the palmar arches and their interconnecting branches present a complex and challenging study. [5] In cases without an efficient collateral circulation, ulnar has clinical significance.…”