手掌部动脉的构筑

本文在手术显微镜下,观察和测量了50侧成人手掌部的动脉。手掌部的动脉,以掌浅层动脉、掌深层动脉和手背动脉形成3个主要血管层次。各层次间的吻合有:1.边缘吻合:位于手掌桡侧和尺侧缘,有浅,深2组。2.中央吻合,包括掌侧浅、深层间的直接交通支和间接交通支;掌侧和背侧间的近侧穿支、掌骨间隙穿支和远侧穿支。掌深弓及分支住手掌动脉构筑中居中间联系位置,对手掌部侧副循环的调节有重要作用。根据Poiscuille定律的流量公式,结合手掌动脉的形态特点推论,手掌部动脉的血液灌流,浅层以尺动脉为主,深层以桡动脉为主;边缘吻合的血液是从掌侧流向背侧;中央吻合的血流主要来自掌深弓及其分支。手掌部动咏的配布存在优势区域。深弓区优于浅弓区和手背动脉网区;中央吻合优于边缘吻合;边缘深层吻合优于浅层吻合。本文还讨论了指动脉的配布。     

左,右手动脉形态的比较研究

成人上肢标本30对,经动脉灌注,解剖观测,比较研究了同一个体左,右手动脉的形态特点。结果表明,形态差异主要在手掌部,且以掌浅层动脉最明显。浅,深两层动脉的管径右手较粗者占多数,而掌浅弓为完全弓型者多见于左手,掌浅层动脉的支数左手较多,桡、尺动脉及其第一级分支间的吻合支也是左手多于右手,说明左手的侧副循环能力比右手强。     

Persistent median artery in the hand: a report with a brief review of the literature

We encountered a persistent median artery in the forearms and hands bilaterally in a 78-year-old Japanese male cadaver during dissection practice at Wakayama Medical University. The brachial arteries divided into the ulnar and radial arteries. The ulnar artery gave off the median and posterior interosseous arteries at the same point, although the anterior interosseous artery was not found. The median artery ran along the median nerve and bifurcated in the hand. In the superficial layer of the palm, one branch of the median artery ran to the ulnar side of the thumb, whereas the other passed to the second interdigital space. The ulnar artery reached the third and fourth interdigital spaces and the ulnar side of the little finger, and showed no anastomosis with the median artery in the superficial layer of the palm. The radial artery did not give off the superficial palmar branch. Therefore, the formation of the superficial palmar arch was incomplete. In the deep layer of the palm, the radial artery formed the deep palmar arch with the deep palmar branch of the ulnar artery and gave off the princeps pollicis artery. In the dorsum of hand, the radial artery passed over the first dorsal interosseous muscle to the index finger and communicated with the palmar pollical artery from the median artery in the first interosseous space. The present study reports an unusual variation of the persistent median artery in the hand and briefly reviews the literature about the median artery.     

A Study of Complete Superficial Palmar Arches Formed Entirely by Ulnar Artery

Superficial Palmar Arch is an arterial arcade and a dominant vascular structure in the palm. It is defined as the anastomosis between the superficial branch of the ulnar artery and supericial palmar branch of the radial artery. In ulnar dominant complete superficial palmar arch, the ulnar artery does not anastomose with radial artery and it terminates by supplying thumb and index finger. In the present study, this type of variation was found in 50% of the hands. This is in contrast to the classical superficial palmar arch normally described where the arch is completed on the radial side by superficial palmar branch of radial artery. In accordance with the present study, a feature that is present in 50% of the specimens cannot be called as a variation. In these cases, without an efficient collateral circulation, ulnar artery occlusion may cause claudication and gangrene in the digits and has clinical significance.     

A morphometric study on the superficial palmar arch of the hand

The vascular anatomy of the hand is a complex and challenging area and has been the subject of many studies. Knowledge of the vascular patterns and diameters of the hand gained more importance with improvements in microsurgical techniques in reconstructive hand surgery. We evaluated 50 hands (26 left, 24 right) of 26 formalin preserved cadavers to determine the superficial palmar arch, its branches and contributing vessels with special attention to the diameters. The symmetry of the types was also evaluated in detail for the first time in the literature. Measurements were made with the help of a digital caliper. The diameters of the ulnar, radial and median arteries were taken at the level of the wrist while the common palmar digital arteries, hypothenar branches and the superficial palmar branch of the radial artery were measured at their origin. Two types of superficial palmar arch were found and defined as complete (43/50 hands) and incomplete arches (7/50 hands). The complete arches were divided into four subgroups and incomplete arches into three subgroups. Most cases were found at the complete AI group (17 hands). Comparison of the arterial diameters showed the ulnar artery was the dominant vessel of the palm. The diameters of the common palmar digital arteries were not different with regard to complete or incomplete arches and between both sides. It looks safe to sacrifice one of the radial or ulnar arteries in some arterial interventions including radial artery cannulation, radial forearm flap and radial or ulnar artery harvesting for bypass grafting if the arch is complete. But we still recommend the noninvasive tests like modified Allen test or Doppler ultrasonography, before performing an invasive arterial intervention. We propose the radiologists to incorporate the median artery into the Doppler dynamic test in particular the existence or the absence of anastomoses between radial and ulnar arteries.This study was accepted as an oral presentation in the “IX National Congress of Anatomists, 7–10 September 2005, Kusadasi, Turkey”     

Multiple variations of the arterial pattern in upper extremities: A case report and embryological pathogenesis

During a routine dissection at the Department of Anatomy, Collegium Medicum, Jagiellonian University, one cadaver was found to have multiple variations of the arteries of the upper limbs. The variations pertained to the course of the brachial artery as well as to its distribution. An unusual formation of the superficial palmar arch was observed in both upper limbs. The anatomical peculiarities encountered included: in the left upper limb—the brachioradial artery, which formed the superficial palmar arch by turning to the palmar side of the hand and connecting with the ulnar artery and in the right upper limb—a subscapular‐circumflex humeral‐deep brachial trunk that correlated with a high division of the brachial artery (in the upper third of the biceps brachii muscle), a large anastomosis between the radial and the ulnar artery, the presence of a persistent median artery, and the unusual formation of the superficial palmar arch, which was created by the median, ulnar, and radial arteries. In this report, we will trace the path of the axillary artery and its branches in detail and emphasize its embryological significance. Clin. Anat. 26:1031–1035, 2013. © 2012 Wiley Periodicals, Inc.     

Deep palmar arch patterns in Brazilian individuals

The deep palmar arch is very important in the blood supply to the hand. Consequently, the radial artery and the deep palmar arch were studied in 60 hands from 30 cadavers of adult Brazilian individuals, of both sexes. The cadavers belong to the Universidade Federal de São Paulo, Brazil. The hand arteries were injected with red stained latex neoprene the deep palmar arch was observed in 59 preparations (98.3%). The arch conformation was classified in two groups, according to the course of the radial artery through the interosseous spaces from the dorsal to the deep palmar region. In group I the radial artery passed through the first interosseous space, and was observed in 51 preparations (85.0%) in group II, the artery passed through the second interosseous space, and was observed in 8 preparations (13.3%). In each group the arches were subdivided according to the number and origin of the deep palmar branch. In group I the arch was formed by the radial artery anastomosing with one deep palmar branch in 41 cases (68.3%), and with two deep palmar branches in 10 cases (16.7%). These branches originated from the ulnar artery, ulnar proper palmar digital artery of the little finger or the common palmar digital artery of the fourth interosseous space. In group II the deep palmar arch was formed by the radial artery anastomosing with one deep palmar branch in 7 cases (11.7%) and in only one case (1.7%) with two deep palmar branches. Knowledge of the arterial variations is very important for surgical procedures in the palmar region.     

Case report of a new variant of double incomplete superficial palmar arch

A rare, unique and previously non-described form of duplicated incomplete superficial palmar arch is reported in the right hand of a male cadaver. The two incomplete arches were formed from the continuation of two terminal palmar branches of the ulnar artery in the distal third of forearm that were connected by a small transverse artery superficial to the flexor retinaculum. Both arches had no contribution from the radial artery. The palmar digital branches from the lateral arch supplied the lateral two-and-a-half fingers, while those from the medial arch supplied the medial two-and-a-half fingers. The thumb and index had additional blood supply from the princeps pollicis and radialis indicis branches of radial artery. The deep palmar arch was entirely formed by the radial artery with no contribution from the ulnar artery. Previous reports on various patterns of superficial palmar arch are highlighted, and the anatomical and clinical importance of the new pattern are discussed.     

Basic vascular anatomy and the reimplantation of the amputated hand through the palm

Summary Thirty adult upper extremities were used to study the blood vessels of the hand by angiography, cross-sectional measurement and operative microscopic dissection. The arteries in the middle segment of the palm are arranged in three planes, while in the upper or lower segment there are two planes only. The division of the territories of the radial and ulnar arteries are not same in the three different layers. There are three main anastomotic pathways between the radial and ulnar arteries in the radial-ulnar direction, while in the palmar-dorsal direction there are three anastomotic zones between the palmar and dorsal planes. According to the rate of appearance, sources, cross-sectional area, irrigation territories and anastomoses of the arteries in the three segments, the clinical significance in the reimplantation of the amputated hand through the palm has been discussed.

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Bases anatomiques de la réimplantation des amputations transpalmaires

Résumé Trente membres supérieurs de sujets adultes ont été étudiés. Les vaisseaux sanguins de la main ont été analysés sur des angiographies, des coupes anatomiques et des dissections sous microscope. Les artères de la paume sont disposées en trois plans dans la partie moyenne, alors que dans les segments sous-jacents, elles sont disposées en deux plans seulement. La disposition des territoires dépendant des aa. radiale et ulnaire n'est pas la même dans chaque plan. Il existe trois voies anastomotiques entre les aa. radiale et ulnaire dans le sens paume-dos de la main. Les possibilités de réimplantation après amputation transpalmaire ont été envisagées grâce à l'étude dynamique de la circulation, à des coupes et à l'analyse des anastomoses artérielles entre ces trois plans.