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Branches of Ulnar Artery in Human Fetuses: Anatomical and Morphometric Study

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Branches of Ulnar Artery in Human Fetuses: Anatomical and Morphometric Study Surgical and Radiologic Anatomy (2019) 41:1325–1332 https://doi.org/10.1007/s00276-019-02297-6 ORIGINAL ARTICLE Branches of ulnar artery in human fetuses: anatomical and morphometric study Selda Yildiz1 · Necdet Kocabiyik1 · Ozlem Elvan2 · Bulent Yalcin1 · Ayhan Comert3 Received: 9 May 2018 / Accepted: 26 July 2019 / Published online: 17 September 2019 © Springer-Verlag France SAS, part of Springer Nature 2019 Abstract Purpose This study was conducted to demonstrate morphological pattern of the ulnar artery and to evaluate morphometri- cally its anatomical branching pattern in human fetuses. Methods Branching pattern of ulnar artery was evaluated on 121 upper limbs of dissected 63 of formalin-fxed fetus cadav- ers with gestational age ranging from 17 to 40 weeks. In order to obtain second and third trimester data, according to their gestational age, two groups were determined. Results In 79 of all 121 upper limbs (65%) ulnar artery gave anterior and posterior ulnar recurrent arteries as separate branches. In this study frequency of presence of a median artery was 46.28% among total examined 121 upper limbs. Median arteries originated from ulnar artery (3.57%) and from the common interosseous artery (53.57%) and anterior interosseous artery (42.85%). Mean distances of the measured parameters were demonstrated according to the gestational age and dif- ferences between group I (second trimester) and group II (third trimester). No statistical diference for groups was observed for gender and between right and left sides. Conclusions Ulnar artery shows predictable patterns during second and third trimester of fetal period and can be suitable access efective alternative for diagnostic and therapeutic coronary interventions. Persistent median artery is important vari- ation and knowledge of its incidence is important for diagnostic difculties and also during awareness of its injury during surgical approaches. Keywords Ulnar artery · Branching pattern · Anatomy · Fetus · Median artery Introduction the radial artery [4]. The ulnar artery, the larger terminal branch of the brachial artery starts 1 cm distal to the fex- Many variations have been reported about arteries of the ion crease of the elbow in adults. In the forearm the artery upper limb [1, 5, 23, 26]. Study of Rodriguez-Niedenfuhr initially lies on brachialis and deep to pronator teres and is et al. [32] demonstrated that there are no signifcant difer- covered by the skin, superfcial and deep fasciae. The ulnar ences between the embryonic and adult arterial variations. nerve lies medially to the distal two-thirds of the artery, Additionally, Kopuz et al. [21] concluded that occurrence of which supplies the nerve throughout its length. In forearm persistent median artery was with remarkably higher rate in it gave anterior and posterior ulnar recurrent arteries and neonatal cadavers than in adult cadavers. In classical sources common interosseous artery. This short branch just after its ulnar artery was reported more variable in its position than origin usually gives of a slender median artery [27, 38]. The ulnar recurrent adipofascial fap is an easy and reli- able option for one stage reconstruction of massive defects * Ayhan Comert around the elbow [15]. Posterior ulnar recurrent artery [email protected] supplies the distal pedicled medial upper arm fap used to cover large elbow defects [30, 31]. The median artery 1 Department of Anatomy, Gulhane Medical Faculty, University of Health Sciences, Ankara, Turkey (arteria comitans nervi mediani, median arter—according to Terminologia Anatomica 1998) is a relatively common 2 School of Health, Mersin University, Mersin, Turkey anatomical variation [10, 17, 33] and the incidence of per- 3 Department of Anatomy, Ankara University Faculty sistent median artery varies from 0.6 [2] to 81.25% [3]. In of Medicine, 06100 Sihhiye, Ankara, Turkey Vol.:(0123456789)1 3 1326 Surgical and Radiologic Anatomy (2019) 41:1325–1332 a previous report of a sample of 60 neonates and infants gestational week) 80 extremities and in group II (27–37 ges- from South African new-borns and infants high frequency tational week) 41 extremities were evaluated. (44.2%) of the median artery of the forearm was reported For dissections surgical microscope Carl–Zeiss OPMI1- [11]. It was stated in Bergman et al. [4] that the incidence FR was used. After longitudinal incision of cubital fossa was on average about 8%. The origin of the median artery superfcial dissection was performed and adipose tissue and in its antebrachial pattern was most frequently directly from fascial layers were removed. After dissection of median the anterior interosseous artery [33]. Then common interos- nerve and brachial artery, bifurcation point of brachial artery seous artery split into the anterior and posterior interosseous and radial and ulnar artery and their branching patterns were arteries. The posterior interosseous artery is usually smaller exposed. Morphological branching pattern of ulnar artery than the anterior interosseous artery. Additionally, posterior was evaluated and variations such as median artery were interosseous recurrent artery leaves the posterior interosse- noted. Following parameters were measured: ous artery near its origin. Based on this artery and venous branches, posterior interosseous artery fap is widely used A: distance between point where anterior recurrent ulnar for reconstructing of the forearm and proximal part of the artery originated and bifurcation point of brachial artery, hand. Knowledge of arterial variations of ulnar artery has a B: distance between point where posterior recurrent ulnar number of important implications for medical practice, but artery originated and bifurcation point of brachial artery, there is scant information regarding its embryological mor- C: distance between point where common recurrent ulnar phological branching pattern. Variations and morphologi- artery originated and bifurcation point of brachial artery, cal pattern of ulnar artery branching and their topographi- D: distance between point where common interosseous cal relation may be important for inadvertent injury during artery originated (or the point where its proximal branch preparations of free forearm fap and may also confuse the originated) and bifurcation point of brachial artery. evaluation of angiographic images [16, 39]. Despite its obvi- ous clinical importance, there is only few reports regarding Measured distances were performed using digital cali- its development and how or when during these variations per. Data analysis was performed using SPSS 16.0 program. arise. In order to increase our current understanding regard- Comparisons of the measurements according to gender and ing development and variations of the ulnar artery and its between groups were performed using an independent sam- branches, more data about ulnar artery morphological pat- ples t test. A paired samples t test was used to compare the tern in human fetuses is needed. The aim of this study was to measurements of right versus left sides. establish the morphometry and anatomical branching pattern of ulnar artery in human fetuses. Results Materials and methods In all cases brachial artery was divided at the neck of the radius to radial and ulnar artery and all branches of the ulnar The study was carried out on 63 formalin-fxed fetus cadav- artery were observed. In 79 of all 121 upper limbs (65%) ers with gestational age ranging from 17 to 40 weeks. Dis- ulnar artery gave anterior and posterior ulnar recurrent arter- sections of fetus cadavers were performed in the Department ies as separate branches (Figs. 1a, 2c). In rest 42 (35%) upper of Anatomy Laboratory of the Gulhane Medical Faculty, limbs anterior and posterior ulnar recurrent arteries were and the rest were performed in the Department of Anatomy originated as a single trunk (Fig. 1b). Laboratory of the Mersin University Faculty of Medicine. The distance (A) between origin of the anterior recur- Fetuses from Mersin University Faculty of Medicine were rent ulnar artery and the bifurcation point of brachial provided from the Pathology Laboratory of the Faculty of artery during second trimester was 2.54 ± 0.77 mm and Medicine of Mersin University with the permission of the 2.59 ± 0.88 mm for right and left sides consequently, ethical committee. Fetuses from Gulhane Medical Faculty and during third trimester was 3.4 ± 2.05 mm and were medicolegally obtained from Ankara Maternity and 4.7 ± 2.63 mm (for right and left sides). The distance (B) Health Academic and Research Hospital. All data about the between origin of the posterior recurrent ulnar artery and gestational age of the fetuses were collected from the hospi- the bifurcation point of brachial artery during second tri- tal. Permission to conduct this study was obtained from the mester was 4.12 ± 01.61 mm and 3.78 ± 1.1 mm for right local ethics committee of Gulhane Military Medical Acad- and left sides consequently, and during third trimester emy. Branching pattern of ulnar artery was evaluated on 121 was 6 ± 1.62 mm and 6.8 ± 2.7 mm (for right and left upper limbs. In order to obtain second (14–26 week) and sides) (Fig. 2a). The distance (C) between origin of the third trimester (27–40 week), data two groups were deter- common recurrent ulnar artery (Fig. 2b) and the bifur- mined. According to their gestational age, in group I (17–26 cation point of brachial artery during second trimester 1 3 Surgical and Radiologic Anatomy (2019) 41:1325–1332 1327 Fig. 1 a Ulnar artery gave anterior and posterior ulnar recurrent arteries as separate branches and median artery stemmed directly from the anterior interosseous artery. Left upper limb. b Anterior and posterior ulnar recurrent arteries were originated as a single trunk and median artery stemmed from the common interosseous artery. Left upper limb was 4.29 ± 1.27 mm and 3.77 ± 1.29 mm for right and In 56 cases of 121 upper limbs (2nd and 3rd trimes- left sides consequently, and during third trimester was ter) forearm type of median artery (arteria comitans nervi 4.51 ± 2.94 mm and 3.98 ± 1.06 mm (for right and left mediani antebrachii) originated from various sites: it can be sides).
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