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Surgical and Radiologic Anatomy

, Volume 41, Issue 7, pp 791–799 | Cite as

Newer insights in the anatomy of superficial palmar arch

  • Dhivyalakshmi Gnanasekaran
  • Raveendranath VeeramaniEmail author
Original Article

Abstract

Purpose

The purpose of the study is to study and classify the superficial palmar arch and its variation based upon the gross dissection and to check the bilateral symmetry of the arches. Specifically, we checked for the presence of the superficial palmar arch as described in the standard textbooks.

Methods

We dissected 55 hands from 28 cadavers of both sexes that include 18 males and 10 females. The superficial palmar arch was carefully dissected and the arteries contributing its formation were traced. It was classified into complete, incomplete arches. Bilateral symmetry of the arches was also studied.

Results

The most common pattern of superficial palmar arch observed is complete. And it is further classified into radio-ulnar and predominantly ulnar types. A consistent proportion of radio-ulnar type arch is completed around first web space. None of the dissected hand meets the definition of the classical superficial palmar arch as described in the standard anatomical textbooks. We also encountered few rare variants of the incomplete superficial palmar arch.

Conclusions

Type 1–4 superficial palmar arch is complete and can be utilized for radial artery or ulnar artery cannulation and radial artery harvesting procedure. In type 5 arch, ulnar artery occlusion could lead to severe hand ischemia and at the same time the radial artery in this type can be harvested without ischemic complication. We suggest that the definition of the complete superficial palmar arch should be rechecked and modified as complete superficial palmar or complete superficial first web space arch.

Keywords

Arterial cannulation Coronary graft Palmar arches Radial artery Ulnar artery 

Notes

Acknowledgements

The authors would like to acknowledge those who had donated the bodies for scientific purpose through the body donation program.

Author contributions

RV: Project development, manuscript editing. DG: Project development, data collection, data analysis, manuscript writing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Al-Turk M, Metcalf WK (1984) A study of the superficial palmar arteries using the Doppler ultrasonic flowmeter. J Anat 138:27–32Google Scholar
  2. 2.
    Arey LB (1957) Developmental anatomy. A text book and laboratory manual of embryology, 6th edn. W B Saunders Co, PhiladelphiaGoogle Scholar
  3. 3.
    Bilge O, Pinar Y, Ozer MA, Govsa F (2006) A morphometric study on the superficial palmar arch of the hand. Surg Radiol Anat 28:343–350CrossRefGoogle Scholar
  4. 4.
    Birch R (2005) Pectoral girdle and upper limb. In: Standring S (ed) Gray’s Anatomy. The anatomical basis of clinical practice, 39th edn. Elsevier Churchill Livingstone, Edinburgh, pp 776–894Google Scholar
  5. 5.
    Coleman SS, Anson BJ (1961) Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynaecol Obstet 113:409–424Google Scholar
  6. 6.
    Doyle JR, Botte MJ (2003) Surgical anatomy of hand and upper extremity, 1st edn. Lippincott, Williams & Wilkins, PhiladelphiaGoogle Scholar
  7. 7.
    Gokhroo R, Bisht D, Saja G, Kishor K, Ranwa B (2016) Palmar arch anatomy: Ajmer Working Group classification. Vascular 24:31–36CrossRefGoogle Scholar
  8. 8.
    Ikeda A, Ugawa A, Kazihara Y, Hamada N (1988) Arterial patterns in the hand based on a three-dimensional analysis of 220 cadaver hands. J Hand Surg Am 13:501–509CrossRefGoogle Scholar
  9. 9.
    Jaschtschinski SN (1896) Morphologie und topographie des arcus volaris sublimis uno profundus des Menschen. Anatomische Hefte 7:161–188CrossRefGoogle Scholar
  10. 10.
    Joshi SB, Vatsalaswamy P, Bahetee BH (2014) Variation in formation of superficial palmar arches with clinical implications. J Clin Diagn Res 8:AC06–AC09Google Scholar
  11. 11.
    Kaplanoglu H, Beton O (2017) Evaluation of anatomy and variations of superficial palmar arch and upper extremity arteries with CT angiography. Surg Radiol Anat 39:419–426CrossRefGoogle Scholar
  12. 12.
    Keen JA (1961) Study of the arterial variations in the limbs, with special reference to symmetry of vascular patterns. Am J Anat 108:245–261CrossRefGoogle Scholar
  13. 13.
    Korambayil PM (2011) Use of superficial palmar arch for bridging the gap in digital revascularisation. Indian J Plast Surg 44:511–4116CrossRefGoogle Scholar
  14. 14.
    Lippert H, Pabst R (1985) Arterial variations in man: classification and frequency. Bergmann, MunchenCrossRefGoogle Scholar
  15. 15.
    Loukas M, Holdman D, Holdman S (2005) Anatomical variations of the superficial and deep palmar arches. Folia Morphol (Warsz) 64:78–83Google Scholar
  16. 16.
    Moore KL, Dalley AF (1999) Clinically oriented anatomy, 4th edn. Lippincott, Williams & Wilkins, PhiladelphiaGoogle Scholar
  17. 17.
    Mozersky DJ, Buckley CJ, Hagood CO Jr, Capps WF Jr, Dannemiller FJ Jr (1973) Ultrasonic evaluation of palmar circulation: a useful adjunct to radial artery cannulation. Am J Surg 126:810–812CrossRefGoogle Scholar
  18. 18.
    Nayak SR, Krishnamurthy A, kumar SM, Prabhu LV, Potu BK, D’costa S, Ranade AV (2010) Palmar type of median artery as a source of superficial palmar arch: a cadaveric study with its clinical significance. Hand (NY) 5:31–36CrossRefGoogle Scholar
  19. 19.
    Olave E, Prates JC, Gabrielli C, Pardi P (1997) Median artery and superficial palmar branch of the radial artery in the carpal tunnel. Scand J Plast Reconstr Surg Hand Surg 31:13–16CrossRefGoogle Scholar
  20. 20.
    Ottone NE, Prum N, Dominguez M, Blasi E, Medan C, Shinzato S, Finkelstein D, Bertone VH (2010) Analysis and clinical importance of superficial arterial palmar irrigation and its variants over 86 cases. Int J Morphol 28:157–164CrossRefGoogle Scholar
  21. 21.
    Patnaik VVG, Kalsey G, Singla Rajan K (2002) Palmar arterial arches—a morphological study. J Anat Soc India 51:187–193Google Scholar
  22. 22.
    Pola P, Serricchio M, Flore R, Manasse E, Favuzzi A, Possati GF (1996) Safe removal of the radial artery for myocardial revascularization: a doppler study to prevent ischemic complications to the hand. J Thorac Cardiovasc Surg 112:737–744CrossRefGoogle Scholar
  23. 23.
    Romanes GJ (2005) Cunnigham’s manual of practical anatomy, vol. 1, 15th edn. Oxford University Press, Oxford, pp 74–104Google Scholar
  24. 24.
    Sawant SP (2013) The anatomical study of variant superficial palmar arch. Int J Curr Sci 6:E 101–106Google Scholar
  25. 25.
    Sherif MM (1994) First dorsal metacarpal artery flap in hand reconstruction. II. Clinical application. J Hand Surg Am 19:32–38CrossRefGoogle Scholar
  26. 26.
    Wagener JF, Rao SV (2015) Radial artery occlusion after transradial approach to cardiac catheterization. Curr Atheroscler Rep 17:489CrossRefGoogle Scholar
  27. 27.
    Zarzecki MP, Popieluszko P, Zayachkowski A, Pekala PA, Henry BM, Tomaszewski KA (2018) The surgical anatomy of the superficial and deep palmar arches: a meta-analysis. J Plast Reconstr Aesthet Surg 71:1577–1592CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Dhivyalakshmi Gnanasekaran
    • 1
  • Raveendranath Veeramani
    • 1
    Email author
  1. 1.Department of AnatomyJawaharlal Institute of Postgraduate Medical Education and Research [JIPMER]PondicherryIndia

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