An anatomical investigation of the superficial and deep palmar arches
Abstract
Background: The superficial palmar arch (SPA) and deep palmar arch (DPA) provide the dominant vascular supply to the hand. The SPA is considered to be highly variable and can be classified as either complete or incomplete. The simplest definition states that the anastomosis between the vessels contributing to the arch represent a complete arch, while an incomplete arch is described as characterised by an absence of anastomosis between the vessels contributing to it. This study aimed to describe the anatomical landmarks, formation and branching patterns of the SPA and DPA. In this study, the SPA and DPA were dissected in 50 specimens (n = 100 adult hands), respectively.
Materials and methods: A complete SPA was observed in 92% of specimens and classified into three types. In Type A (44%), the SPA was formed by the anastomosis of the superficial palmar branch of the radial artery with the ulnar artery. Type B (46%) was formed by the ulnar artery alone and Type C (2%) was formed by anastomosis of the ulnar artery with the superficial palmar branch of the radial artery and the persistent median artery.
Results: An incomplete SPA was observed in 8% of the specimens and divided into three types formed by the radial and ulnar arteries. The DPA was divided into five types viz. Type G (72%), where the DPA was formed by anastomosis of the deep palmar branch of the radial artery (DPBRA) with the deep palmar branch of the ulnar artery (DPBUA). Type H (12%), was formed by anastomosis of the DPBRA, the DBUA and the interosseous artery. Type I (8%), was formed by the anastomosis of the DPBRA with the superior and inferior DPBUA. Type J (4%), the deep ulnar artery had two branches whereby either one branch anastomosed with the DPBRA to form the DPA. Type K (4%), the DBUA exhibited two deep branches with one branch anastomosing with the DPBRA to complete the DPA.
Conclusions: The interosseous artery anastomosed with either the DPA or the additional DPBUA. Knowledge of the variability of the SPA and DPA is crucial for safe and successful hand surgeries.
Keywords: superficial palmar archdeep palmar archradial arteryulnar artery
References
- Al-Turk M, Metcalf WK. A study of the superficial palmar arteries using the Doppler Ultrasonic Flowmeter. J Anat. 1984; 138 ( Pt 1): 27–32.
- Aughsteen AA. Case report of a new variant of double incomplete superficial palmar arch. Anat Sci Int. 2012; 87(1): 56–59.
- Baetz L, Satiani B. Palmar arch identification during evaluation for radial artery harvest. Vasc Endovascular Surg. 2011; 45(3): 255–257.
- Bilge O, Pinar Y, Ozer MA, et al. A morphometric study on the superficial palmar arch of the hand. Surg Radiol Anat. 2006; 28(4): 343–350.
- Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesth Analg. 2009; 109(6): 1763–1781.
- Fazan VP, Borges CT, Da Silva JH, et al. Superficial palmar arch: an arterial diameter study. J Anat. 2004; 204(4): 307–311.
- Feigl GC, Petrac M, Pixner T, et al. The superficial palmar arch and median artery as an example of misleading results due to a small number of investigated specimens or the use of different classifications. Ann Anat. 2012; 194(4): 389–395.
- Jachtschinski SN. Morphologie und Topographie des Arcus volaris sublimes und prefundus des Menchen. Anat Helf. 1897; 7: 161–188.
- Lippert H, Pabst R. Arterial variations in man: classification and frequency. J.F. Bergmann (Springer). 1985: 74–75.
- Loukas M, Holdman D, Holdman S. Anatomical variations of the superficial and deep palmar arches. Folia Morphol (Warsz). 2005; 64(2): 78–83.
- McLean KM, Sacks JM, Kuo YR, et al. Anatomical landmarks to the superficial and deep palmar arches. Plast Reconstr Surg. 2008; 121(1): 181–185.
- Mookambica RV, Nair V, Nair R, et al. Incomplete superficial palmar arch. Int J Anat Variations. 2012.; 3: 65–66.
- Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. Sixth Edition. Lippincott Williams and Wilkins (Wolters Kluwer) 2010: 775–782.
- Olave E, Prates JC. Deep palmar arch patterns in Brazilian individuals. Surg Radiol Anat. 1999; 21(4): 267–271.
- Ruengsakulrach P, Eizenberg N, Fahrer C, et al. Surgical implications of variations in hand collateral circulation: anatomy revisited. J Thorac Cardiovasc Surg. 2001; 122(4): 682–686.
- Standring S, Borley NR, Collins P. et al. Gray’s Anatomy, The Anatomical Basis of Clinical Practice. Fortieth edition. Churchill Livingstone (Elsevier) 2009: 2321–2330.
- Takkallapalli A, Kalbande S, Dombe D, et al. 2011. Variations in the formation of superficial palmar arch and its clinical significance in hand surgeries. Int J Biol Med Res. 2011; 2(2): 543–546.
- Tank PW. Grant’s Dissector. 14thEdition. Lippincott Williams and Wilkins (Wolters Kluwer) 2009: 41–46.
