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Superficial Palmar Arch: an Arterial Diameter Study

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Superficial Palmar Arch: an Arterial Diameter Study J. Anat. (2004) 204, pp307–311 BRIEFBlackwell Publishing, Ltd. COMMUNICATION Superficial palmar arch: an arterial diameter study Valéria Paula Sassoli Fazan,1,2 Celso Teixeira Borges,2 Jefferson Hilário da Silva,2 Abadio Gonçalves Caetano2 and Omar Andrade Rodrigues Filho2 1Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil 2Department of Biological Sciences, School of Medicine of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil Abstract Although anatomical variations in the arterial pattern of the hand have been the subject of many studies, infor- mation on the diameter of the superficial palmar arch contributing vessels and its branches are rarely found in the literature. The objective of the current study was to evaluate these arterial variations, with special attention to the diameter of the superficial palmar arch contributing vessels and its major branches. Forty-six hands from male embalmed human cadavers were evaluated, 21 right hands and 25 left hands. Complete arches were present in 43% on the right and in 52% on the left. Arches were completed by the median artery in two cases. Variations were more common at the radial side of the arch and on left hands. Comparison of vessel diameters revealed the radial artery to be significantly larger than the ulnar artery but the ulnar artery to be larger than the superficial branch of the radial artery. The diameters of the common digital arteries were not different with regard to complete or incomplete arches, or with regard to the presence of the median artery. Key words arterial variations; hand; median artery; radial artery, ulnar artery; vascular anatomy. because, based on anatomical studies, new surgical Introduction procedures can be proposed. Omokawa et al. (2001) The high incidence of anatomical variations in the proposed two different reverse island flaps for large arterial pattern of the hand has been the subject of many palmar defects of the fingers based on a cadaver study anatomical studies (McCormack et al. 1953; Coleman of the arterial branches supplying the midpalmar & Anson, 1961; Jelicic et al. 1988; Gajisin & Zbrodowski, area. In that study, the authors evaluated the arterial 1993; Gellman et al. 2001; Ruengsakulrach et al. 2001). diameter of the cutaneous perforating arteries. The The superficial palmar arch is a dominant vascular objective of the current study was to evaluate the arterial structure of the palm of the hand and, together with variations, with special attention to the diameter of the deep palmar arch, provides the blood supply to all the vessels forming the superficial palmar arch and the fingers. Recent progress in hand surgery has engen- its major branches. The purpose of this study was to add dered a need for precise knowledge of the frequency of new information on the diameter of these vessels anatomical variations in the superficial palmar arch with respect to the presence or absence of a complete and its branches (Jelicic et al. 1988). Very little information superficial palmar arch and to correlate the findings is available in the literature on the diameter of the with laterality information. superficial palmar arch and its branches. Knowledge of the size of these vessels is important in improving Materials and methods microsurgical techniques in reconstructive hand surgery Forty-six hands from 25 male embalmed human cadavers (fixed in 10% formaldehyde solution) were studied. Correspondence Anomalous tortuosities, dilatations, aneurisms or Dr Valéria Paula Sassoli Fazan, MD, PhD, Department of Surgery and atheromatous/occlusive disease tissues were discarded Anatomy, School of Medicine of Ribeirão Preto – USP, Ave. Bandei- rantes 3900, Ribeirão Preto, SP 14049–900, Brazil. T: +55 16 602 2407; at the beginning of the study. An anatomically normal F: +55 16 633 0017; E: [email protected] superficial palmar arch was defined as a direct continuity Accepted for publication 21 January 2004 between the ulnar artery and the superficial branch of © Anatomical Society of Great Britain and Ireland 2004 308 Superficial palmar arch vessels diameters, V. P. S. Fazan et al. Fig. 1 (A) Example of a right superficial palmar arch, as classically described in the literature, showing all the branches measured in the current study. A, ulnar artery; B, superficial branch of the radial artery to the superficial palmar arch; C, radial index artery, as a branch of the 1st common digital artery (#); D, princeps policis artery as a branch of the 1st common digital artery (#). Asterisks indicate the 2nd, 3rd and 4th common digital arteries. Arrow indicates the digitus minimus artery. (B) Schematic drawing of a left superficial palmar arch, as classically described in the literature, including all its branches measured in the current study. *, The radial artery continuation, after giving off its superficial branch; **, the deep branch of the ulnar artery, to the deep palmar arch. Letters indicate the site of arterial diameter measurements. A, radial artery; B, superficial branch of the radial artery to the superficial palmar arch; C, ulnar artery to the superficial palmar arch; D, princeps policis artery as a branch of the 1st common digital artery (J); E, radial index artery, as a branch of the 1st common digital artery (J); F, 2nd common digital artery; G, 3rd common digital artery; H, 4th common digital artery; I, digitus minimus artery. (C) The most common variation reported here: note the presence of a small radial artery branch to the arch (dashed line) that arose dorsally and passed into the palm to reach the ulnar artery. (D) An incomplete superficial palmar arch, with contributions from both ulnar and radial arteries. (E) An incomplete superficial palmar arch formed only by the ulnar artery. (F) An incomplete superficial palmar arch in which the median artery substitutes the radial artery vascular territory. (G) A superficial palmar arch in which the median artery substituted the radial artery to complete the arch. the radial artery (Agur & Lee, 1991; Clemente, 1997; and description of the anatomical variations were Gellman et al. 2001). The main branches of the sup- carried out for the ulnar and radial arteries and for the erficial palmar arch were considered as being the three superficial palmar arch and its branches. common digital arteries (Coleman & Anson, 1961; Ger With the aid of an electronic digital caliper (range et al. 1996) and the proper digital artery to the ulnar of 0–300 mm, resolution 0.01 mm, Gehaka, SP, Brazil), border of the fifth digit (digitus minimus artery) the arterial diameters were measured as represented (Agur & Lee, 1991; Clemente, 1997; Gellman et al. 2001). in Fig. 1(B). If a median artery contributed to the sup- When an arterial trunk, which provided the origin to erficial palmar arch, its diameter at wrist level was also a major vessel to the thumb (princeps policis artery) and measured. Arterial diameters were compared between another vessel to the radial side of the index finger sides (right and left) and between arteries. For this (radial index artery), originated from the superficial comparison, data were tested for normal distribution palmar arch, this was considered as the first common by the Kolmogorov–Smirnov normality test (Ong & digital artery (Al-Turk & Metcalf, 1984; Clemente, 1997). LeClare, 1968; Rosenthal, 1968). If the data presented Therefore, the classical three common digital arteries a normal distribution, comparisons were made by the were named as second to fourth (Fig. 1A). Quantification unpaired Student’s t-test. Otherwise, comparisons were © Anatomical Society of Great Britain and Ireland 2004 Superficial palmar arch vessels diameters, V. P. S. Fazan et al. 309 made by the Mann–Whitney test (Mann & Whitney, Table 1 Mean diameter of the ulnar and radial artery, at wrist 1947). Differences were considered significant if P < 0.05. level, on the presence of a complete or incomplete superficial palmar arch Results Complete superficial Incomplete superficial palmar arch palmar arch Forty-six hands were evaluated in total, 21 on the right Right Left Right Left and 25 on the left. A complete superficial palmar arch was present in 43% of the right hands and in 52% of Radial artery 3.1 ± 0.2 3.1 ± 0.2 2.6 ± 0.3* 2.7 ± 0.2* the left hands. In these cases, arches completed by the Ulnar artery 2.5 ± 0.2# 2.6 ± 0.1# 2.6 ± 0.2 2.6 ± 0.2 median artery were included (one case on the right and Data are expressed as mean ± standard error of mean (SEM). one case on the left) (Fig. 1G). Incomplete arches (57% *Significant difference between diameters of the radial arteries on the right and 48% on the left) are represented in on hands with complete and incomplete superficial palmar arches. Fig. 1(D,E). The normal superficial palmar arch, formed #Significant difference between diameters of radial and ulnar arteries on hands with complete superficial palmar arches. by the ulnar artery and the superficial branch of the radial artery (Fig. 1A), was found in 48% of cases on each side. (dorsalis pollicis artery) showed an average diameter The most common variation in superficial palmar of 1.7 ± 0.1 mm, which was not different (Mann–Whitney arch anatomy was the presence of a small radial artery test, P = 0.19) from the superficial branch of the radial branch to the arch, arising dorsally (dorsalis pollicis artery present in the normal complete arches. artery; Agur & Lee, 1991), at the level of origin of the In the two hands in which a complete superficial princeps pollicis artery, which passed into the palm palmar arch was formed by the ulnar and median arteries, to reach the ulnar artery (Fig. 1C). This variation was the mean diameter of the median artery at wrist level found in 33% of the left hands and in 20% of the right was 1.7 ± 0.3 mm, which was significantly smaller than hands.
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