Vascular Anatomy of the Hand in Relation to Flaps

Tan, Ruth En Si; Lahiri, Amitabha

doi:10.1016/j.hcl.2019.08.001

Cited by 24 publications

(21 citation statements)

References 28 publications

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“…The knowledge of arterial anatomy of the thumb and associated variation is crucial for the surgeon performing reconstructive surgeries on the thumb. In the current study, the RPDA and UPDA were present in 96% and 100% which is similar to Earley [7] Ikeda et al [12] Ramírez and Gonzalez [15] and, Tan and Lahiri [19] The UPDA was seen in 100% of the dissected limbs similar to the above studies. On the other hand, the RDDA and UDDA were present in 11% and 7% only, which contradicts the observation by previous studies (Table 4) [7,12,15].…”

Section: Discussionsupporting

confidence: 90%

Reappraisal of arterial anatomy of thumb

2022

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The nomenclature of arteries supplying the thumb and its sources arteries differs between the studies. This makes difficulty in understanding the irrigation pattern to the thumb. The main purpose of this study was to identify the proper digital arteries supplying the thumb on its radial and ulnar side from both the palmar and dorsal aspect. Also this study aimed to trace its source and classify with proper definition with the review of blood supply to thumb. Dissection was carried out in 55 hands form 28 freshly embalmed adult human cadavers of both genders. The proper digital arteries to the thumb and its source arteries were carefully traced and defined. Thumb receives its dominant blood supply mostly from its palmar side. The ulnar palmar digital artery was seen in all the dissected hand (100.0%) whereas; the radial palmar digital artery was present in 53 hands (96.4%). The radial dorsal digital artery and ulnar dorsal digital artery were observed in only 10.0% and 7.3%. The most common source of both the palmar digital arteries to thumb was from first palmar metacarpal artery (FPMA). In majority of the hands, in addition to the radial or ulnar palmar digital arteries from the FPMA, there were also additional palmar digital arteries arising from the superficial palmar arterial system. The universal naming of the proper digital arteries to the thumb as well as its source arteries is mandatory for the proper understanding of normal as well as variant arterial anatomy of thumb.

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Section: Discussionsupporting

confidence: 90%

Reappraisal of arterial anatomy of thumb

2022

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“…These arches deliver arterial blood to the digits thus distal capillary refill can be used to assess adequacy of circulation after ulnar artery cannulation. 27,28 In clinical practice, noninvasive methods commonly used to demonstrate persistent collateral flow to the hand while the index vessel is compressed include the modified Allen test and Barbeau test. 29,30 The predictive value of these tests for the risk of downstream ischemia in the case of arterial occlusion has not been validated in pediatric patients and their correlation with effective collateral flow is controversial in the adult literature.…”

Section: Ta B L E 1 Population Characteristicsmentioning

confidence: 99%

The ulnar artery: A site suitable for arterial cannulation in pediatric patients

Roux

Kohn

Sinskey

et al. 2021

Pediatric Anesthesia

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Background: Historically, the ulnar artery has rarely been considered for arterial cannulation as it is less easily palpated than the radial artery. With the current routine use of ultrasound in pediatric patients, the ulnar is as accessible as the radial and could be viewed as an equivalent site for cannulation. Aims:The purpose of this study was to compare ulnar and radial artery suitability for arterial cannulation in pediatric patients using 2-dimensional ultrasound. Methods:We examined the ulnar and radial arteries of pediatric patients aged birth to 6 years who were scheduled to undergo general anesthesia. Following anesthesia induction, the investigators positioned the patient's wrist to 30-45 degrees of extension and obtained images of the ulnar and radial arteries in the transverse and longitudinal planes. Assessments of the arteries' anterior-posterior diameter, cross-sectional area and depth were made by visual inspection at the time of image acquisition and by electronic caliper measurement of recorded images. Results:In 108 patients, mean anterior-posterior diameter of the ulnar artery was larger than the radial artery in the transverse view, longitudinal view, and crosssectional area in 63.6%, 59.4%, and 60.4% of patients (p = .002, .004, and .006, respectively). Mean ulnar artery size was, on average, larger than the radial artery by 7.7%, 8.1%, and 12.9% in the transverse AP diameter, longitudinal AP diameter, and cross-sectional area (95% CI 3.1-12.4%; 3.2-13.0%; 4.4-21.5%). The investigator's visual evaluation of vessel size at the bedside showed substantial agreement with the measured cross-sectional area (linear-weighted kappa of 0.73). In a subset of 13 patients age <24 months, the mean depth of the ulnar artery was 2.13 mm compared to 1.65 mm for the radial artery (difference −0.48 mm 95% CI 1.08-0.12). Conclusions:The ulnar artery was larger than the radial artery in 60% of pediatric patients thus may offer an arterial cannulation site advantage due to its larger size. The use of 2-dimensional ultrasound examination allows accurate assessment of upper extremity distal arteries in order to optimize site selection for arterial cannulation in pediatric patients.

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“…The cardiac catheterization is frequently used in diagnosis or treatment of certain cardiovascular conditions, while radial arterial cannulation precedes hemodialysis or arterial blood gas analysis. On the other hand, ultimate choice in some interventions may be complete removal of the radial artery which serves as coronary artery bypass graft (CABG) or takes part in vascularized skin flaps that are nowadays widely used in microsurgery [26]. In both cases, it is essential to assess the existence of collateral circulation in hand before performing the procedures.…”

Section: Discussionmentioning

confidence: 99%

Anatomical variations of the superficial palmar arch and its clinical relevance

et al. 2022

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Backgorund / Aim. In-depth knowledge of the vascular network of hand is of great importance in modern medicine. The main vessel of hand is the superficial palmar arch. As typically described in anatomical textbooks, it arises as terminal branch of the ulnar artery which then anastomoses with the superficial palmar branch of the radial artery. However, the superficial palmar arch is characterized by remarkable variability, which was the area of interest of many researchers so far. Comprehensive examination of the anatomy of the superficial palmar arch which included two parameters - the formation of the superficial palmar arch and its localization in relation to the topographic landmarks of the hand. Methods. Research was conducted on a total number of 14 cadavers. After careful dissection, variations and distance of the superficial palmar arch 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 < 0.05. Results. According to Coleman and Anson classification, the higher incidence of incomplete type (57.14%) of the superficial palmar arch should be in comparison to complete type (42.86%). In addition to this, a statistically significant difference discovered in distance of the superficial palmar arch from Kaplan?s cardinal line between two groups with complete and incomplete types, respectively. The parameter examined in the group with complete type took the value of 2.13 ? 0.32 cm, while in the group with incomplete type measured 3.33 ? 0.87 cm. Conclusion. The present study showed a very important complexity in the domain of anatomy of the superficial palmar arch 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.

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Vascular Anatomy of the Hand in Relation to Flaps

Cited by 24 publications

References 28 publications

Reappraisal of arterial anatomy of thumb

Reappraisal of arterial anatomy of thumb

The ulnar artery: A site suitable for arterial cannulation in pediatric patients

Anatomical variations of the superficial palmar arch and its clinical relevance

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