Indian Journal of Clinical Anatomy and Physiology
Indian Journal of Clinical Anatomy and Physiology (IJCAP) is an open access, peer-reviewed medical quarterly journal, published since 2014 under the auspices of the Innovative Education and Scientific Research Foundation (IESRF), which aims to uplift researchers, scholars, academicians, and professionals in all academic and scientific disciplines. IESRF is dedicated to the transfer of technology and research by publishing scientific journals, research content, providing professional memberships, and conducting conferences, seminars, and award programs....
Study of contributing arteries to superficial palmar arch formation
Abstract
The superficial palmar arch (SPA) is formed predominantly by the ulnar artery with a contribution from the superficial palmar branch of the radial artery.
Aim: To study contributing arteries in superficial palmar arch formation and variations in its formation.
Material and Methods: Study comprised of 30 upper limbs from 15 cadavers. Palmar arches in them were dissected following classical incisions and dissection procedures of Cunninghams’ manual.
Results: SPA was formed by superficial branch of ulnar artery only in 13.33% specimens, by superficial branch of both ulnar and radial artery in 70% specimens, by superficial branch of ulnar and persistent median artery in 13.33% specimens and was formed by superficial branches of ulnar and radial arteries with persistent median artery in 3.33% specimens. SPA was complete in 80% and was incomplete in 20% specimens.
Conclusion: The arch formation is highly variable. Knowledge of contribution to the SPA will be helpful to the reconstructive hand surgical procedures such as arterial repairs, vascular graft applications and re-implantations.
Introduction
Superficial palmar arch (SPA) is formed by direct continuation of ulnar artery beyond flexor retinaculum. It is often not a complete arch. If it is complete it becomes continuous with superficial palmar branch of radial artery. [1] About a third of the superficial palmar arches are formed by the ulnar artery alone; a further third are completed by the superficial palmar branch of the radial artery; and a third by the arteria radialis indicis, a branch of either arteria princeps pollicis or the median artery. [2] So there are different views on contributing arteries and completeness of arch formation in different books. So aim of this study is to note usually contributing arteries and variations related to superficial palmar arch (SPA) formation. Objectives of this study are 1) study of contributing arteries to superficial palmar arch formation. 2) to note superficial palmar arch is complete / incomplete. 3) to note any variation present / absent.
Materials and Methods
Study was done on 15 formalin (10%) embalmed adult cadavers, 11 males & 4 females (30 sides). Decomposed, amputed, injured and specimens from children were excluded from study. Vertical incision was taken on Palm and skin reflected laterally. Palmar aponeurosis was identified with palmaris longus (PL) tendon. PL tendon was cut and aponeurosis reflected distally. Median and ulnar nerve & their branches in relation to arteries forming superficial palmar arch & flexor retinaculum were dissected meticulously till digital branches.
Results
SPA was formed by superficial branch of ulnar artery only in 4 cases out of 30 (13.33%) ([Figure 1]). SPA was formed by superficial branch of both ulnar and radial artery in 21 cases out of 30 (70%) ([Figure 2], [Figure 3]). SPA was formed by superficial branch of ulnar and persistent median artery in 4 cases out of 30 (13.33%) ([Figure 4]). And in single case SPA was formed by superficial branches of ulnar and radial arteries with persistent median artery (3.33%) ([Figure 5]).
With respect to complete and incomplete arch formation of superficial palmar arch, it was observed that in 24 cases out of 30, SPA was complete (80%) ([Figure 2], [Figure 4]) and in 6 cases out of 30, arch was incomplete (20%) ([Figure 1], [Figure 3], [Figure 5]).
|
Contributing arteries |
Ulnar artery only |
Ulnar and radial arteries |
Ulnar and median arteries |
Ulnar, median and radial arteries |
|
Anitha et al[3] |
_ |
_ |
6% |
Absent |
|
Coleman and Anson[4] |
37% |
68% |
3.8% |
1.2% |
|
Ikeda et al[5] |
_ |
_ |
0.9% |
Absent |
|
Adachi[6] |
_ |
_ |
9% |
_ |
|
Jaschts chinski S. N[7] |
38% |
_ |
_ |
_ |
|
MAJ Mozersky DJ et al[8] |
88% |
_ |
_ |
_ |
|
Earley[9] |
20% |
_ |
_ |
_ |
|
Gellman H et al[10] |
31.1% |
_ |
_ |
_ |
|
Suman U et al[11] |
50% |
_ |
_ |
_ |
|
Present study |
13.33% |
70% |
13.33% |
3.33% |
|
SPA Authors |
Complete |
Incomplete |
|
Moore KL ; clinically oriented anatomy[12] |
34.5% |
65.5% |
|
Coleman et al[4] |
78.5% |
21.5% |
|
Ikeda et al[5] |
96.4% |
3.6% |
|
Gellman et al[10] |
84.4% |
15.6% |
|
Al Turk & Metcalf[13] |
84.4% |
15.6% |
|
Anitha et al[3] |
75% |
25% |
|
Present study |
80% |
20% |
Discussion
Present study was compared with previous studies in view of arteries contributing in formation of SPA as shown in [Table 1]. Results of present study are comparable with studies of Coleman and Anson[4] and Earley.[9]
In view of complete / incomplete SPA, present study is compared with previous studies as demonstrated in table no. 2. Results of present study are equivalent to that of Coleman et al,[4] Gellman et al,[10] Al Turk and Metcalf,[13] Anitha et al[3] studies.
Conclusion
The findings suggest that majority of hands showed complete arch which indicates that collateral circulation is present in majority of cases.
While harvesting radial artery for use as arterial bypass conduits or while harvesting the free radial forearm flap, the need to look specifically for variation in collateral circulation, like presence of incomplete arch is a must. Knowledge of usual contributing arteries and its anatomical variations is important for hand surgeries, such as arterial repairs, vascular grafts.
Source of Funding
None.
Conflict of Interest
The authors declare no conflict of interest.
References
- Mcminn R. Wrist and hand. Last’s anatomy regional and applied. 1995. [Google Scholar]
- Willams P, Bannister L, Berry M. . Gray's Anatomy. 2000. [Google Scholar]
- Anitha T, Kalbande S, Dombe D. Variations in the formation of superficial palmar arch and its clinical significance in hand surgeries. Int J Biol Med Res. 2011;2(2):543-6. [Google Scholar]
- Ikeda A, Ugawa A, Kazihara Y, Hamada N. Arterial patterns in the hand based on a three-dimensional analysis of 220 cadaver hands. J Hand Surg Am. 1988;13:501-9. [Google Scholar]
- Coleman S, Anson B. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet. 1961;113:409-24. [Google Scholar]
- Adachi B. Das arterien-systemder Japaner, Kenkyusha. Koyoto. 1928;1:368-89. [Google Scholar]
- Jaschts S. Morphologi e and topographie des arcus volaris sublimis and profundus. Anat Hefte. 1897;7:163-88. [Google Scholar]
- Mozersky D, Buckley C, Hagood C, WC, Dannemiller F. Ultrasonic evaluation of the palmar circulation. A useful adjunct to radial artery cannulatio. Am J Surg. 1973;126(6):810-2. [Google Scholar] [Crossref]
- Earley M. The arterial supply of the thumb, first web and index finger and its surgical application. J Hand Surg. 1986;IIB(2):163-74. [Google Scholar]
- Gellman H, Botte M, Shankwiler J, Gelberman R. Arterial patterns of the deep and superficial palmar arches. Clin Orthop Relat Res. 2001;383:41-6. [Google Scholar]
- Suman U, Jayanthi K. A study of complete superficial palmar arches formed entirely by ulnar artery. J Anat Soc India. 2011;60(2):199-201. [Google Scholar]
- Al-Turk M, Metcalf WK. A study of the superficial palmar arteries using the Doppler Ultrasonic Flowmeter. J Anat. 1984;138:27-32. [Google Scholar]
- Moore K, Dalley A. . Clinically Oriented Anatomy. 1999. [Google Scholar]
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- DOI 10.18231/j.ijcap.2021.061
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- Citation
- Received Date August 11, 2021
- Accepted Date September 24, 2021
- Publication Date December 07, 2021