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Variability in the topography of the arteries of the upper extremity is associated with fetal development. Determination of individual anatomical variants of the upper extremity blood supply at different stages of ontogeny, especially in human fetuses, is of great practical importance in vascular surgery. Aim of the study. To study the individual anatomical variability of the ulnar and radial arteries in human fetuses of different ages. Material and methods. The study of variants of the topography of the branches of the radial and ulnar arteries, the peculiarities of the formation of the superficial palmar arterial arch was carried out on 46 preparations of the upper extremities of 23 human fetuses 81. 0-375, 0 mm parieto-coccygeal length using macromicroscopic dissection, vascular injection and morphometry without external signs of anatomical abnormalities or congenital malformations of skeletal, fascial-muscular and vascular-nerve structures of the upper extremities. Results and discussion. Our study demonstrated fetal anatomical variability and bilateral asymmetry of the right and left upper extremity arteries in human fetuses. Thus, in a fetus with a PCL of 210.0 mm, the right brachiocephalic artery was found to originate from the right axillary artery. It should be noted that the initial portion of the right brachiocephalic artery passed anteriorly, not posteriorly, to the median nerve, and at the level of the middle third of the anterior shoulder region, the artery occupied a superficial position relative to the median nerve, which is located in the lateral bicuspid groove of the shoulder. The brachiocephalic artery was then directed in an oblique lateral direction to the lateral surface of the forearm. In this fetus, a high origin of the right ulnar artery was found, which originated from the trunk of the brachiocephalic artery in the upper third of the right anterior shoulder region. At the border of the middle and lower thirds of the anterior shoulder region, the ulnar artery crossed the ulnar nerve anteriorly and passed with it in the median biceps groove of the shoulder. 3.0 mm below the beginning of the ulnar artery, the superior circumflex ulnar artery bifurcated from the brachiocephalic artery, and in the lower third of the anterior shoulder region, a common trunk bifurcated from the brachiocephalic artery and bifurcated into the middle and inferior circumflex ulnar arteries. We found arterial anastomoses between the latter and branches of the ulnar artery. The immediate continuation of the right brachiocephalic artery in the palm was the brachiocephalic artery of the thumb. At the level of the base of the proximal phalanx of the thumb, the brachiocephalic artery branched into three palmar finger arteries, which were directed to both edges of the palmar surface of the first finger and the radial edge of the palmar surface of the second finger. The superficial palmar arch was formed by the superficial palmar branch of the brachial radial artery, the terminal ulnar artery, and the anterior interosseous artery. Four common palmar arteries originated from the superficial palmar arch and were directed to the ulnar edge of the palmar surface of the second finger and the palmar surfaces of the adjacent edges of the third through fifth fingers. The left superficial palmar arch had an atypical structure located under the palmar aponeurosis at the level of the middle of the metacarpals and formed by the terminal parts of the ulnar and anterior interosseous arteries. Because the radial artery in this fetus was traced to the distal part of the forearm (to the scaphoid bone), we did not find branches of this artery in the palm area, especially the superficial palmar branch of the radial artery. The ulnar artery was directed caudally to the palmar region, curving slightly in an arc to the radial side of the hand. From the terminal portion of the ulnar artery, three common palmar finger arteries bifurcated, which in turn bifurcated into five palmar finger arteries of their own. The latter supplied the ulnar edge of the third finger and the palmar areas of the fourth and fifth fingers. The radial edge of the third finger and the palmar areas of the II-I fingers were supplied by five separate palmar arteries originating from the terminal portion of the anterior interosseous artery. Anastomoses were found between the palmar arteries, mainly in the middle and terminal phalanges. In the area of the palm, numerous muscular branches bifurcated from the anterior interosseous and ulnar arteries, providing blood supply to the palm muscles. Conclusions. In the majority of the studied fetuses (82.61 %) the superficial palmar arch was closed, in 17.39 % of the observations it was not closed. In 10.5 % of cases, the superficial palmar arch was formed by the trunk of the ulnar artery and the median forearm artery, and in 5.2 % - with the participation of the ulnar and anterior interosseous arteries. The ulnar artery is predominantly involved in the formation of the superficial palmar arch. In a fetus with a PCL of 210.0 mm, the right brachiocephalic artery was found, as well as a high origin of the right ulnar artery from it and an atypical branching of other branches. In particular, the superficial palmar arch was formed by the superficial palmar branch of the brachial radial artery, the terminal ulnar artery, and the anterior interosseous artery, while the left superficial palmar arch was formed by the terminal ulnar and anterior interosseous arteries. [ABSTRACT FROM AUTHOR]

Palmar arterial arches are of immense importance as they are the only source of blood supply to the hand and deep arterial arch. Its anatomical variations are described in the literature. Anatomical variations are important as far as surgical procedures are concerned. So detailed morphological study of superficial palmar arches is conducted at the Department of Anatomy, Dr. D. Y. Patil Medical College, Kolhapur, on 100 hands of 50 cadavers. Incomplete palmar arch, complete palmar arch contributed by median artery and ulnar artery, complete arch formed by ulnar artery alone are notable findings. Knowledge of anatomical variations of the arterial pattern of the hand is crucial for safe and successful hand surgery. Although there is number, of variations reported in the arterial supply of palm, present study will be helpful for surgeons. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study is to present a relatively rare case of the coexistence of an incomplete superficial palmar arch and a Berrettini anastomosis, identified in a cadaveric specimen, and further discuss the potential clinical implications of such anatomical variations. Case Report. The variation was found in the left hand of a formalin-fixed male cadaver of Greek origin, that was dissected under an operating microscope (x4, x10 magnification) in our Anatomy Department. In the specimen, we found an incomplete superficial palmar arch, formed only by the superficial branch of the ulnar artery, and a Type 1 Berrettini Anastomosis, originating from the ulnar nerve and joining a branch of the median nerve. Conclusion. To avoid iatrogenic damage and permanent loss of sensation, hand surgeons and microsurgeons should be aware of the presence of a BA, and the potential coexistence of this variation with vascular abnormalities in the hand that may complicate surgical procedures. [ABSTRACT FROM AUTHOR]

Superficial palmar arch (SPA) is a dominant vascular structure in the palmar region that provides a major blood supply to fingers. Present case describes a rare formation and branching pattern of SPA in a formalin fixed cadaveric left hand. In this case, SPA was formed by the anastomoses between radial artery (RA) and the superficial brachioulnar artery (SBUA), which is defined as an ulnar artery with a high origin in the arm. More interestingly, unlike classic literature, SPA sends out six branches instead of four, and the principle artery of thumb arises directly from SPA instead of RA. The aforementioned variations have rarely been reported in previous literature and demonstrate important clinical significance for accidental intra-arterial injections, errors in blood pressure readings, as well as orthopedic, plastic and vascular surgeries of the upper limbs. [ABSTRACT FROM AUTHOR]

The superficial palmar arch is an important anatomical structure that contributes to the arterial supply of the palmar side of the hand in the upper extremity. However, there is limited information on the embryological morphological structure of the superficial palmar arch in the literature. We studied the types of the superficial palmar arch and determined their variations by dissecting 80 upper extremities of 40 formalin-fixed human fetuses (19 males, 21 females) 18–37 weeks of age. The types and variations of the superficial palmar arch were examined, and the median artery was imaged. The superficial palmar arch type was complete in 58 hands (72.5%) and incomplete in 22 hands (27.5%). The complete group consisted of type A (47.5%), type B (16.25%), type C (3.75%), type D (1.25%), and type E (3.75%). On the other hand, the incomplete group consisted of type F (15%), type G (8.75%), type H (2.5%), and type I (1.25%). A median artery that originated from the ulnar artery and passed through the carpal tunnel during its course was detected in two hands (2.5%). Knowledge of the superficial palmar arch variations will contribute to hand microsurgery particularly in vascular graft and free flap application interventions for arterial bleeding in the palmar region. [ABSTRACT FROM AUTHOR]

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.

The superficial palmar arch (SPA) is an important anastomotic network primarily formed by the superficial branch of the ulnar artery with one of the superficial branches of the radial artery. SPA variations were observed in three out of 20 cadaveric hand specimens. Two cases of unilateral incomplete SPA and the third case of a unilateral ulnar-to-median complete SPA were recorded. The incomplete SPA was located superficial to the flexor digitorum tendons and deep to the palmar aponeurosis. SPA in the remaining 17 hands was anatomically normal, with major contributions from the superficial palmar branch of the ulnar artery and minor contributions from the superficial palmar branch of the radial artery. These variations are clinically important, especially during procedures like arterial blood sampling, cardiac catheterization, and hemodialysis. Thus, anatomical variabilities in this region may cause complications with vascular occlusion if not ascertained before the procedure. [ABSTRACT FROM AUTHOR]

The median artery typically regresses after two months of intrauterine life, although it may persist into adulthood in some individuals. The presence of a persistent median artery (PMA) may be associated with other anatomical variations including a bifid median nerve. In the present cadaveric study, we report a rare variation of bilateral asymmetry of PMA associated with the bifid median nerve, and unilateral variation of the origin and course of the palmar cutaneous branch of the median nerve (PCBMN) which to our knowledge, is the first study to report all these variations in an individual. Classical dissection of the upper limb was performed on a 45-year-old male cadaver. The cadaver was donated to the Department of Anatomy at Kerman University of Medical Sciences. Bilateral PMA was observed in both upper limbs. The PMA originated from the ulnar artery and contributed to the formation of an incomplete superficial palmar arch (SPA) on both sides; however, the branching pattern of these arteries was different between the right and left hands. Also, a bilateral high division of the median nerve was observed proximal to the carpal tunnel. We also encountered a very rare variation of PCBMN, in which it originated from the ulnar side of the median nerve, and passed beneath the flexor retinaculum of the left hand. Awareness of anatomical variations of the median nerve and also the presence of PMA is of utmost importance due to their implication in carpal tunnel syndrome and surgical complications., Competing Interests: Declarations. Competing interests: The authors declare that they have no conflict of interest. Ethical approval: The studied cadaver was derived from body donation with informed consent, written and signed by the donator himself. The cadaver belongs to the Department of Anatomy at Kerman University of Medical Sciences., (© 2024. The Author(s), under exclusive licence to Japanese Association of Anatomists.)

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.

A 45-year-old male prisoner was referred to the orthopedic outpatients clinic after he sustained a blunt palmar injury when he tried to break-up a bag of ice with the volar aspect of his hand. A few months later a pulsatile expansile mass developed at the site of blunt trauma affecting flexion and extension of the fingers and inability to hold objects. A computed tomography angiogram confirmed the mass to be a true aneurysm of the superficial palmar arch 3 cm in size. The patient was referred to the vascular surgery department where the aneurysm was dissected and ligated with removal of the thrombus with no reconstruction of the vessel necessary. The patient had an uneventful recovery with return of full function., Competing Interests: The authors hereby declare that there are no financial or other type conflicts of interest in the creation of this article. There is no related funding source, no animal experiment, no trial number and written consent was obtained from the patient., (© 2024 The Authors.)

Non-contrast-enhanced (CE) magnetic resonance angiography (MRA) techniques are of considerable interest for diagnosing vascular diseases in the upper extremities owing to the possibility of repeated examinations, sufficient coverage of the measurement volume, and because possible side effects of administering iodine- or gadolinium-based contrast agents and radiation exposure can be avoided. The aim of this study was to investigate the feasibility of an optimized electrocardiogram (ECG) triggered Cartesian quiescent interval slice selective (QISS) technique for MRA of hand arteries. Both hands of 20 healthy volunteers (HVs) were examined using an optimized QISS-MRA pulse sequence at 1.5 Tesla. The wrist and hand arterial trees were divided into 36 segments. Cross-sectional areas (CSA) of all arterial segments were measured. For the technical evaluation of the pulse sequence, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were computed and six imaging artifacts were graded. Two experienced observers used an ordinal scoring system to assess the image quality of each arterial segment. Interobserver agreement was determined. The median CSA was 7.3 mm2 in the ulnar and radial artery, 3.2 mm2 in the four common digital arteries, and 1.5 mm2 in five proper digital arteries. The median SNR and CNR of the third common proper arteries were 45.9 and 20.3, respectively. None of the arterial segments were contaminated by venous enhancement. The image quality of arterial segments for both hands was considered as diagnostic in 87.2% of all 1440 segments. An interobserver agreement of 0.67 for both hands was determined for image quality of arterial segments using a five-grade scoring system. Optimized QISS-MRA allows as the first MRA technique the classification of superficial palmar arch (SPA) and deep palmar arch (DPA) variants. 5 new SPA and 6 new DPA variants could be classified using QISS-MRA in comparison with previous studies using CE computed tomography angiography and using fixed cadaver hands. By using this optimized 2D Cartesian QISS-MRA protocol, contrast agent-free angiography of the wrist and hand arteries provided a high in-plane spatial resolution and an excellent visualization of small digital arteries. • High-resolution, non CE MRA of the wrist, hand and digital arteries using optimized 2D ECG triggered Cartesian QISS at 1.5 T. • Optimized 2D ECG triggered Cartesian QISS-MRA allows complete suppression of venous signal intensity in digital arteries. • This pulse sequence allows for the first time the classification of superficial / deep palmar arch and (SPA/DPA) variants. • 5 new SPA and 6 new DPA variants could be classified in comparison with studies using CE CTA and using fixed cadaver hands. [ABSTRACT FROM AUTHOR]

The objective of this work consists in the analysis of the position of the superficial palmar arch in the palm of the hand, with identification of the origin, form of disposition, present anastomosis and termination of the same, providing the own experience and comparing it with the referents of the area, without carrying out a comparison of classifications, but on the contrary, seeking to analyze the information from a clinical-surgical point of view, demonstrating the importance of knowledge of the real anatomy of the superficial palmar arch when addressing the vascular anatomy of the hand in all kinds of pathological situations. [ABSTRACT FROM AUTHOR]

There is an infrequent disposition of the first metacarpal artery which results in an anastomosis with the common palmar digital artery of the second space, forming an anastomotic system between the deep radial system and the superficial ulnar system. The radial system in turn, through the first dorsal interosseous artery, anastomoses with a collateral of the common palmar digital artery of the second space, ending as the ulnar palmar digital artery of the thumb and establishing a second anastomotic system. A third anastomosis is established in one case, between the common palmar digital artery of the fourth space and the fourth metacarpal artery. To this may be added the classic anastomosis between the superficial branch of the ulnar artery and the deep branch of the radial artery, i.e. the deep palmar arch. [ABSTRACT FROM AUTHOR]

Background: The superficial palmar arch is a crucial blood supply to the palm. However, it exhibits significant variations, posing challenges in surgical procedures. Gaining a comprehensive understanding of the relationship between different types, physiological indices, and the clinical significance of the superficial palmar arch will enhance the accuracy of diagnosing and treating patients., Materials and Methods: In this study, we dissected a total of 72 specimens, comprising 39 males and 33 females. We observed the type, length, and diameter of the superficial palmar arch and analyzed its correlation with the disease. Additionally, we conducted Doppler ultrasound measurements on 20 healthy volunteers (10 males and 10 females) and 18 patients with superficial palmar arch injury (10 males and 8 females) to assess the classification, diameter, intimal thickness, and blood flow velocity of the superficial palmar arch. We collected information on 9 male patients with finger fracture and observed the classification of the superficial palmar arch, fracture healing time, and basic function recovery time. Lastly, we analyzed rare variant specimens encountered during the anatomy process., Results: In the exploration of human anatomy, there were four types of superficial palmar arch: ulnar artery arch type in 17 cases (23.61%), radial ulnar artery type in 46 cases (63.89%), ulnar artery without arch type in 6 cases (8.33%), and 3 cases (4.17%) of double arch type of radial and ulnar artery. One case non-arched type was found in imaging examination (5%). In one elderly male specimen, the hand's superficial palmar arch artery was tortuous and dilated. In addition, there was a positive correlation between the diameter and length of the superficial palmar arch (except the second common palmar digital artery in women), among which the ulnar artery and the third common palmar digital artery had the strongest correlation. Compared to healthy volunteers, patients with ulnar injury in the Radial-ulnar artery type exhibited a decrease in the diameter and blood flow velocity of the ulnar artery, as well as the second and third common palmar digital arteries. No such change was observed in patients with radial injury. Additionally, patients with ulnar injury in other types of Radial-ulnar artery also experienced a decrease in the diameter and blood flow velocity of the ulnar artery. Finger fracture patients with Ulnar artery with arch and Ulnar artery without arch had shorter fracture healing time and basic function recovery time compared to those with Radial-ulnar artery type., Conclusions: This study investigated the relationship between the classification, physiological index, and clinical significance of the superficial palmar arch at all levels. The results demonstrated that when the superficial palmar arch is damaged, it is important to consider both the classification and the site of damage, as this can potentially result in improved therapeutic outcomes. These findings provide a basis for future clinical research.

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.

The superficial palmar arch (SPA) is formed by the union of the ulnar artery and the superficial palmar branch of the radial artery. From its convexity four branches emerge, known as the common palmar digital arteries. We propose to carry out a review of the description of the SPA in contrast to the dissections carried out. Sixty-one hands were dissected and studied. Analysis of the SPA: Classic variant of the SPA: 23 cases (37.7 %). Nonclassic variant of the SPA: 15 cases (24.6 %). Type A: 13 cases (86.7 %). Anastomosis between the ulnar artery and the first dorsal metacarpal artery. Type B: 2 cases (13.3 %). Anastomosis between the ulnar artery and the satellite artery of the median nerve. Absence of the arch: 23 cases (37.7 %) Type A: 19 cases (82.6 %). The ulnar artery is the only one present in the plane of the SPA. Type B: 3 cases (13 %). The ulnar artery and the superficial palmar branch of the radial artery are in the plane of the superficial palmar arch, there is no anastomosis between them. Type C: 1 case (4.4 %). The ulnar artery and the satellite artery for the median nerve are in the plane of the SPA, there is no anastomosis between them. Analysis of the fifth common palmar digital artery: The fifth common palmar digital artery originates from the different variants in 41 cases (67.2 %). Based on the results, we recommend at the time of dissecting consider that: The classic variant is not the most frequent to find. The absence of the arch is verified in the same percentage rate as the classic variant. Even when the SPA is present, the percentage rate of the non-classic variant is significant. The fifth common palmar digital artery is a constant collateral branch of the superficial palmar arch. [ABSTRACT FROM AUTHOR]

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.

Abstract Introduction The following study aimed to find the pooled prevalence estimate of anatomical variations in the palmar vasculature, namely the superficial palmar arch (SPA) and the deep palmar arch (DPA). The importance of understanding the vasculature of the hand has become critical with the increasing use of hand microsurgery. Methods Major online medical databases (PubMed, EMBASE, ScienceDirect, and Web of Science) were extensively searched for terms pertaining to the SPA, the DPA, and their anatomy and variations. Articles reporting data on the SPA and/or the DPA were collected and their data extracted. Furthermore, a reference search was performed, allowing to pinpoint any articles that were not previously found. The collected data were analyzed using MetaXL 5.3. Results The analysis included 36 studies (n = 4841 palmar arches). The SPA was found to be complete in 81.3% of cases, with the radioulnar anastomosis being the most common variant (72.0%). The incomplete SPA was present in 18.7% of cases, with the ulnar artery supplying the third finger from both radial and ulnar side as the most prevalent in 34.8%. The DPA was found to be complete in 95.2% of cases. Conclusion In this study, the SPA was predominantly complete, with the anastomosis between the radial and the ulnar artery being most prevalent. Furthermore, the DPA was also complete in the vast majority of cases. The palmar arches and their variations should be kept in mind when considering the use of palmar vasculature for cardiac catheterization and other medical procedures, due to the risk of iatrogenic ischemic hand complications. [ABSTRACT FROM AUTHOR]

Background: The blood supply of the hand is complex and challenging. Awareness of the anatomical variationis necessary not only for the anatomist but also for surgeons. The ulnar artery provides a major blood supply to the hand with the assistance of the radial artery in the form of the superficial palmar arch. The objective of this study was reported a rareanatomical variation of the superficial palmar arch. Materials and Methods: The anatomical variation described was found during routine dissection performed by medical students of second semester in a 75-year-old male embalbed adult cadaver in the laboratory of Morphology of the University of Pamplona. Results and Discussion: In the right hand, the superficial palmar arch only gave rise to two common palmar digital arteries. In the left hand, the arch provided common palmar digital arteries which ran into the first, third and the fourth spaces and one proper palmar digital for the little finger. The arch does not supply the second intermetacarpal space. Conclusions: Less critical knowledge of vasculature of the hand might lead iatrogenic injury during surgery, microvascular surgery for revascularization, replantation and composite tissue transfers. [ABSTRACT FROM AUTHOR]

Background The deep lymphatic anatomy of the hand still remains the least described in medical literature. Methods Eight hands were harvested from four nonembalmed human cadavers amputated above the wrist. A small amount of 6% hydrogen peroxide was employed to detect the lymphatic vessels around the superficial and deep palmar vascular arches, in webs from the index to little fingers, the thenar and hypothenar areas. A 30-gauge needle was inserted into the vessels and injected with a barium sulphate compound. Each specimen was dissected, photographed and radiographed to demonstrate deep lymphatic distribution of the hand. Results Five groups of deep collecting lymph vessels were found in the hand: superficial palmar arch lymph vessel (SPALV); deep palmar arch lymph vessel (DPALV); thenar lymph vessel (TLV); hypothenar lymph vessel (HTLV); deep finger web lymph vessel (DFWLV). Each group of vessels drained in different directions first, then all turned and ran towards the wrist in different layers. Conclusion The deep lymphatic drainage of the hand has been presented. The results will provide an anatomical basis for clinical management, educational reference and scientific research. [ABSTRACT FROM AUTHOR]

Background: The proper palmar digital arteries arise infrequently from dorsal metacarpal arteries. This work reports the second dorsal metacarpal artery unusual ending and a vascular variation related to the superficial palmar arch.Materials and Methods: Fresh human upper limbs routine dissection, from a male cadaver, injected with coloured elastomeric material, immersed in 10% formalin.Results: The second dorsal metacarpal artery presented terminal branches, the index finger medial proper digital palmar artery and the middle finger lateral proper digital palmar artery. At the division point of both terminal branches, the second dorsal metacarpal artery anastomoses with a thin forth common digital palmar artery.Conclusions: The value of this knowledge about the infrequent vascular dispo-sition lies in vascularised flaps design using the second dorsal metacarpal artery. (Folia Morphol 2018; 77, 2: 393-396). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

Aim: To evaluate the abnormalities and variations of the arterial system of upper extremities and superficial palmar arch with computed tomography angiography and to guide the clinician during this procedure. Methods: A total of 156 upper extremities of 78 cases were retrospectively analyzed using computed tomography angiography. The study was approved by the local ethics committee of the hospital. From the analysis of the computed tomography angiography images, the following information was recorded; the diameters and abnormalities of radial, ulnar and brachial arteries in both upper extremities, the presence of atherosclerotic changes or stenosis in these arteries, whether the superficial palmar arch was complete or incomplete, and arterial dominance. Also, the computed tomography angiography classification of superficial palmar arch distribution and anatomic configuration was performed. Results: The mean baseline diameters of the radial, ulnar and brachial arteries of the cases were; 2.8 ± 0.6, 2.5 ± 0.7, and 4.7 ± 0.6 mm, respectively. A complete superficial palmar arch was observed in 69.2 % of the right hands and 70.5 % of the left hands. For the superficial palmar arches on the right side, the radial artery was dominant in two and the ulnar artery was dominant in 47 with the remaining showing codominance. On the left side, the radial artery was dominant in one hand, with the ulnar artery being dominant in 49 cases, and in 28 cases, there was codominance. In the superficial palmar arch classification, four of the arches (A-D) were defined as complete and the remaining three (E-G) as incomplete. Conclusion: The current study clarified different variations in palmar circulation and forearm arteries to aid the surgeon during trans-radial or trans-ulnar catheterization, hemodialysis, or coronary artery bypass grafting. [ABSTRACT FROM AUTHOR]

A persistent median artery is a rare anomaly. It accompanies the median nerve along its course in the forearm and is of variable origin. It is associated with other local anatomical variations and may contribute significantly towards formation of the superficial palmar arch. In embryos, it is responsible mainly for the blood supply to the hand. The objective of this study was to research the frequency, type (forearm or palmar) and origin of the median artery in fetuses, correlating its presence with sex and body side. Red-colored latex was injected into 32 brachial arteries of human fetuses until its arrival in the hand could be seen. Twenty-four hours after the injection, the median arteries were dissected without the aid of optical instruments. Among the 32 forearms dissected, the median artery was present in 81.25 % (26) of the cases, and it was found more frequently in females and on the left side. Regarding origin, most of the median arteries originated in the common interosseous artery (38.5 %) and anterior interosseous artery (34.6 %). The mean length of the median arteries was 21.1 mm for the palmar type and 19.8 mm for the forearm type. The median artery has a high rate of persistence. It is important to be aware of this anatomical variation, since its presence may give rise to difficulties during routine surgical procedures on the wrist. Its presence may cause serious functional complications in the carpal tunnel, anterior interosseous nerve, round pronator syndromes, and ischemia of the hand. [ABSTRACT FROM AUTHOR]

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.