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Introduction: Single-portal endoscopic carpal tunnel release using modified Agee technique is widely used in Vietnam. Yet information on the anatomy of the target space of Vietnamese people regarding this technique is scarce. We aimed to characterise the anatomical landmarks and variations of the carpal tunnel to propose a safer surgery. Materials and methods: All twenty hands of ten fresh frozen, unembalmed cadavers of Vietnamese adults were included. Dissection was performed after the vertical line, Kaplan’s cardinal line and the distal wrist crease were drawn. The transverse carpal ligament (TCL), ulnar neurovascular bundle and superficial palmar arch were exposed. Measurements were made using Mitutoyo calliper. The variants of the median nerve and in the course of the thenar motor branch were recorded. Results: The median distances from the TCL distal margin to the distal wrist crease and superficial palmar arch were 31.2mm and 12.7mm, respectively. The ulnar neurovascular bundle was located 5.7mm and 4.4mm ulnar to the vertical line at the level of the TCL proximal margin and at the level of the TCL distal margin, respectively. The thenar motor branch of the median nerve was extra-ligamentous in 19 hands and preligamentous in 1 hand. Conclusion: If endoscopic portal is made along the distal wrist crease, blade assembly should not be inserted beyond the 35mm mark on its scale. Instruments should be aimed toward the radial border of the patient’s ring finger. Surgeons should be aware of the preligamentous course of the thenar motor branch although this variant type is rare.

Introduction: The superficial palmar arch (SPA) is the main source of arterial supply to the palm. It is an arterial arcade formed mainly by the ulnar artery and is completed by the superficial palmar branch of the radial artery. The study was conducted with objective to study the variations in formation of superficial palmar arch in Nepalese cadaveric hands. Methodology: Two horizontal incisions were made, one at the wrist joint and another incision along the root of fingers. A vertical incision was made from the middle of the wrist to the 3rd metacarpo-phalangeal joint. The skin of the palm and the palmar aponeurosis was reflected. The surrounding adipose tissue was removed to view the superficial palmar arch and its branches. Result: In present study, out of 50 specimens of hands, 64% of superficial palmar arch was formed as normal pattern and in 36% cases it was formed by ulnar artery alone. Normal SPA pattern was seen 63% in male and 66.7% in female i.e. higher percentage in female than in male but it was statistically insignificant (P

Background: During the surgical exposure of carpal tunnel, it is possible to injure neurovascular structures, especially the superficial palmar arch (SPA) due to its proximity to the flexor retinaculum. Hence, the topographical location of SPA is necessary to avoid iatrogenic injuries. Size of the vessels forming SPA is important to carry out new procedures in the microsurgical techniques in reconstructive surgeries. Materials and Methods: The present study was conducted on 40 cadaveric hands obtained from AJ Institute of Medical science, Mangalore. The distance between the SPA and distal wrist crease (DWC) and Kaplan's cardinal line (KCL) were measured. Diameters of arteries which are mainly contributing in the formation of SPA and its branches were measured with a digital caliper, and mean and standard deviation were calculated. Results: The distance of SPA, from DWC was 44.22 ± 4.98 mm and from KCL along the lateral and medial border of ring fingers was 8.32 ± 1.01 mm and 9.54 ± 0.95 mm, respectively. The average diameter of the ulnar artery was 2.84 mm; radial artery was 2.79 mm; the superficial palmar branch of the radial artery, princeps pollicis artery, and the median artery was 1.5 mm, 1.24 mm, and 2.025 mm, respectively. Conclusion: The results of the present study on the location of the SPA as well as arterial diameters will be of great help for the surgeons and radiologists. Advances in reconstructive surgeries of the hand, especially microsurgeries has entailed a better understanding of arterial variations, in-depth knowledge of which is necessary for the positive outcome of surgical procedures.

Abstract Introduction The superficial palmar arch is the main contributor to the vascular supply of the hand. Numerous anatomical variants have been described and there are multiple classifications of the superficial palmar arch available. The Kaplan cardinal line is used occasionally as a reference to identify the deep structures of the hand. However, there are also multiple variants of the line and multiple reports regarding the structures that can be identified with it. Material and Methods Ten anatomical dissections of hands were performed in seven cadaveric specimens. The anatomical variants of the superficial palmar arch were recorded, as well as their relationship with the Kaplan cardinal line. A review of the available literature was made. Results According to the classification by Coleman et al, the most common type was the complete superficial palmar arch, present in seven hands, while the incomplete superficial palmar arch was found in three hands. The most frequent complete palmar arch was type IB, followed by type IIB, and finally type IA and type IIA. The most common relation was with the Kaplan cardinal line type A to the apex of the arch and with type B to the curvature of the ulnar artery. Conclusions There is a great anatomical variability in the superficial palmar arch. There was a greater frequency of the complete superficial palmar arch, with the ulnar artery being the dominant vascular supply. The Kaplan cardinal line can be used as a safety limit to avoid the superficial palmar arch if it is drawn to intersect the pisiform bone. Clinical Relevance It is important to be aware of the anatomical variants of the superficial palmar arch, as well as of its relationship with the superficial structures of the hand to be able to perform invasive or reconstructive procedures and to preserve the vascularity of the hand.

Arterial variations are common in upper extremity. The present article describes a case of higher division of brachial artery. Higher division of brachial artery occurred above the level of insertion of coracobrachialis muscle. Further, the brachial artery proper continues lateral to median nerve in the cubital fossa and divides into radial and ulnar artery at the level of neck of radius. Higher division of brachial artery continues downward and medially, medial to the median nerve in cubital fossa, forming the superficial palmar arch in the palm. Knowledge of such variation is extremely important, especially for the limb surgeons (for carrying out surgeries in arm, creating arteriovenous fistulas for dialysis), routine blood pressure measurements, radiographic imaging, and interventionists. The relevant topics of embryology, anatomy, and its clinical importance have been discussed in the literature review. The purpose of this article is to highlight the need for the awareness of the potential existence of such anatomical variation and how it can be preoperatively detected by color Doppler imaging, which would help the surgeons and clinicians to plan out surgery and therapeutic interventions.

Τhe superficial palmar arch (SPA) is usually formed by an anastomosis between the ulnar artery (UA) and the radial artery (RA) and gives off three common palmar digital arteries. Many variations of the SPA have been reported in the pertinent literature (ulnar type arch, radial type arch, complete and incomplete arch, etc). Complete SPA is reported to be formed in the 69.2 % of the right hands and 70.5 % of the left hands in the pertinent literature. We report a case of a complete ulnar type SPA, where the first and second palmar digital arteries emerge from a common stem.

Objectives: Arterial arches of the hand are very important for orthopedic surgeons as well as microvascular surgeons while doing surgeries on hand. The greatest risk associated with harvesting the radial artery for coronary artery bypass grafting is ischemia of the soft tissues of the hand. There may be numerous variations in the formation of these arterial arches which will be important for the surgeons. So, for the above-mentioned reasons the following study was undertaken to look for the pattern of superficial arches in hands and its variations. Materials and Methods: The study was done on 75 formalin fixed upper limbs from the Department of Anatomy. Incision was given according to Cunningham manual of anatomy and superficial palmar arch was exposed, and its formation from different branches was noted down. The variations were noted down in the formation of superficial palmar arch to provide a database of the normal and variant anatomy. Results: In 77.3% of specimens superficial palmar arch was complete and in 22.6% of specimens it was incomplete. Conclusion: The variations found in this study will help not only the anatomists, but also orthopedics and microvascular surgeons who do surgery on hands. Current progress in the microsurgical procedures for reconstructive hand operations needs the understanding of variant arterial arches, the comprehensive knowledge of which is vital for the surgical interventions and successful outcome of the surgeries.

The knowledge of variations in the vascular architecture of hand is of great importance to surgeons, orthopedicians, and plastic surgeons in microsurgical procedures following crush injuries of the hand and amputations. The efficiency of collateral circulation in hand is essential in few peripheral vascular diseases like Raynaud′s disease and harvesting of the radial artery for the coronary bypass graft. During routine dissection of the right upper limb of a 55-year-old male cadaver, we observed that the superficial palmar arch (SPA) is formed by the ulnar artery and completed by the first dorsal metacarpal artery. After completing the arch, dorsal metacarpal artery continued as princeps pollicis artery for the thumb. The common palmar digital artery supplying the contiguous side of index and middle fingers passed through the neural loop formed by the proper digital nerve supplying the radial side of the middle finger and joined with the unusually large first palmar metacarpal artery before dividing into proper digital arteries. The first palmar metacarpal artery also gave origin to radialis indicis artery which in turn ran deep to tendons of the index finger to reach index finger. The common palmar digital artery supplying the contiguous side of middle and ring fingers also passed through the neural loop formed by the proper digital nerve supplying the ulnar side of the middle finger. The deep palmar branch of ulnar artery gave proper digital artery to little finger.

In this article we describe a rare variation in the superficial palmar arch (SPA) encountered during routine cadaveric dissection. SPA was formed by the superficial branches of ulnar and radial arteries which provided a proper digital branch to the ulnar side of the little finger and three common palmar digital branches to the medial four digits. Additionally a first common digital artery was seen to emerge from the radial side of SPA which further divided into the arteria princeps pollicis and arteria radialis indicis. We also found a small communicating branch between the arteria princeps pollicis and the radial artery in the anatomical snuff box. Such arterial variations in the palm due to alteration in the developmental sequence remains a crucial issue in the reconstructive hand surgeries, especially while dealing with the innovative microsurgical procedures, where these varied patterns act as pivotal points around which successful results of various advanced surgical procedures revolve.

Introduction: The hand in the humans, is abundantly supplied by blood by two anastomotic arches, they are being the superficial palmar arch (SPA) and the deep palmar arch (DPA). These two arterial arcades are formed by the anastomosis between the two main arteries of the forearm ie. the radial, the ulnar and their branches. The anatomy of the palmar vascular arches and their variations were one of the most interesting and challenging anatomical areas , traditionally the superficial palmar arch is formed by the union of superficial palmar branch of the ulnar artery with the superficial palmar branch of the radial artery or with the arteria radialis indicis , with the ulnar artery as the main feeding vessel . Aim of the study: The fact that frequent anatomic variations in the arterial pattern of hand drew our attention so as to ascertain the prevalence of variations in the SPA of south Tamilnadu population. Materials And Methods: In our study we took fifty (50) disarticulated upper limbs from 25 adult human cadavers, which included both the sexes. All the cadavers were from the department of anatomy, which were used for routine undergraduate teaching. All the cadavers were embalmed and stored in tanks and all the limbs were dissected as per the instructions given by Cunnighams manual of practical anatomy,including the hand and if any variations found were noted and photographed. Results: In our study we came across two variations in two different hands unilaterally on the right side belonging to male sex. In both the hands we found double superficial palmar arches, without median artery. Conclusion: The present study has revealed details about some of the variations of superficial palmar arch in humans which will be supplementing our already existing knowledge of variations. Recent advances in the microvascular surgical techniques for reconstructive hand surgeries have made mandatory, the clear understanding of variant arterial arches encountered in our population, so a comprehensive knowledge of which will be useful for the hand surgeons and orthopedicians for surgical intervention and for a successful outcome after surgery.

Traumatic hand injuries resulting in segmental loss of common digital artery are not uncommon. To bridge the gap and repair of transected common digital artery, the superficial palmar arch could be divided proximally on radial side and turned distally to the common digital artery for revascularisation. Revascularisation of the transversely crushed common digital artery can be performed based solely on superficial palmar arch for revascularisation of the segmental loss of common digital artery. However, because of known variability in the palmar arch, intraoperative verification is needed to ensure safe transfer of arch.

Background: Knowledge of the variations in the arterial supply of hand has reached a point of practical importance with the advent of microvascular surgery for revascularization, replantation and composite tissue transfers. Arterial supply of hand is derived from two anastomotic arches, formed between two main arteries of forearm i.e. radial, ulnar and their branches, in the palm. Objective: The superficial palmar arch shows variation in formation at the radial side. In the present study we have recorded its data which would help in its clinical and surgical implications. Materials and Methods: In the present study we have studied the formation of superficial palmar arches and their variations in 100 cadaveric hands at Dr. D . Y. Patil Medical College, Pune and B.J. Government Medical College, Pune, India. Result and Conclusion: According to Adachi’s classification the most predominant pattern obseved was of Ulnar type arch (66%). According to Coleman and Anson classification 82% showed complete (Group I) superficial palmar arches and a very low incidence (18%) of incomplete arches (Group II). This suggests that collateral circulation is present in majority of cases. This would result in least number of complications considering radial artery harvesting for coronary bypass. Sub-classification of arches according to Coleman and Anson 1961 indicates that the predominant type in the present study was of Group I (Type B) which is formed entirely by Ulnar Artery (56%). Median artery and ulnar artery forming an incomplete superficial arch under Group II (Type C) having an incidence of 4% was recorded. Thus in such cases radial artery harvesting for coronary artery bypass may prove to be less fatal. This study is an effort to provide data about the formation of superficial palmar arches which has been a centre of attraction for most of the surgical procedures and injuries of the hand.