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
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
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
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
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
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.
Article DOI
