Sridevi P: Study of contributing arteries to superficial palmar arch formation


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).

Figure 1

Illustration showing incomplete superficial palmar arch formed by superficial branch of ulnar artery(UAs) only, supplying 5 fingers

https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/b904f33c-e4be-43ee-a8dd-5606adfd579b/image/4f75fe98-5633-4bf1-862e-162d8ab15eb3-uimage.png

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).

Figure 2

Illustration showing complete superficial palmar arch formed by superficial branch of ulnar artery (UAs) and superficial branch of radial artery (RAs) supplying 5 fingers

https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/b904f33c-e4be-43ee-a8dd-5606adfd579b/image/07478aae-d48e-443a-9772-b1b032a69897-uimage.png

Figure 3

Illustration showing incomplete superficial palmar arch formed by superficial branch of ulnar artery (UAs) and superficial branch of radial artery (RAs) supplying 5 fingers

https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/b904f33c-e4be-43ee-a8dd-5606adfd579b/image/fdbae1f5-1365-43a6-be9a-545c83f7365c-uimage.png

Figure 4

Illustration showing complete superficial palmar arch formed by superficial branch of ulnar artery(UAs) and persistent median artery (PMA) supplying medial 4 ½ fingers

https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/b904f33c-e4be-43ee-a8dd-5606adfd579b/image/e6930d37-df92-404c-b9b6-89d1a1a8cece-uimage.png

Figure 5

Illustration showing incomplete superficial palmar arch formed by superficial branch of ulnar artery (UAs), persistent median artery (PMA) and superficial branch of radial artery (RAs) supplying 5 fingers

https://typeset-prod-media-server.s3.amazonaws.com/article_uploads/b904f33c-e4be-43ee-a8dd-5606adfd579b/image/428797e6-9821-4cee-b132-e5642a222e46-uimage.png

Table 1

Comparison of findings of present study with previous studies in view of arteries contributing in formation of superficial palmar arch

Contributing arteries

Ulnar artery only

Ulnar and radial arteries

Ulnar and median arteries

Ulnar, median and radial arteries

Anitha et al3

_

_

6%

Absent

Coleman and Anson4

37%

68%

3.8%

1.2%

Ikeda et al5

_

_

0.9%

Absent

Adachi6

_

_

9%

_

Jaschts chinski S. N7

38%

_

_

_

MAJ Mozersky DJ et al8

88%

_

_

_

Earley9

20%

_

_

_

Gellman H et al10

31.1%

_

_

_

Suman U et al11

50%

_

_

_

Present study

13.33%

70%

13.33%

3.33%

Table 2

Comparison of present study findings with previous studies in view of complete or incomplete formation of superficial palmar arch

SPA Authors

Complete

Incomplete

Moore KL ; clinically oriented anatomy12

34.5%

65.5%

Coleman et al4

78.5%

21.5%

Ikeda et al5

96.4%

3.6%

Gellman et al10

84.4%

15.6%

Al Turk & Metcalf13

84.4%

15.6%

Anitha et al3

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 Anson4 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 al3 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

1 

RMH Mcminn Wrist and handLast’s anatomy regional and applied9th editionChurchill LivingstoneNew York1995110

2 

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T Anitha S Kalbande D Dombe Variations in the formation of superficial palmar arch and its clinical significance in hand surgeriesInt J Biol Med Res2011225436

4 

A Ikeda A Ugawa Y Kazihara N Hamada Arterial patterns in the hand based on a three-dimensional analysis of 220 cadaver handsJ Hand Surg Am1988135019

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SS Coleman BJ Anson Arterial patterns in the hand based upon a study of 650 specimensSurg Gynecol Obstet196111340924

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B Adachi Das arterien-systemder Japaner, KenkyushaKoyoto1928136889

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DJ Mozersky CJ Buckley CO Hagood WF Capps FJ Dannemiller Ultrasonic evaluation of the palmar circulation. A useful adjunct to radial artery cannulatioAm J Surg19731266810210.1016/s0002-9610(73)80077-7

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MJ Earley The arterial supply of the thumb, first web and index finger and its surgical applicationJ Hand Surg1986IIB216374

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H Gellman MJ Botte J Shankwiler RH Gelberman Arterial patterns of the deep and superficial palmar archesClin Orthop Relat Res2001383416

11 

U Suman K Jayanthi A study of complete superficial palmar arches formed entirely by ulnar arteryJ Anat Soc India2011602199201

12 

M Al-Turk W K Metcalf A study of the superficial palmar arteries using the Doppler Ultrasonic FlowmeterJ Anat19841382732

13 

KL Moore AF Dalley Clinically Oriented Anatomy10th editionWilliams and WilkinsPhiladelphia: Lippincott1999751



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Article History

Received : 11-08-2021

Accepted : 24-09-2021

Available online : 07-12-2021


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https://doi.org/10.18231/j.ijcap.2021.061


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