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Analysis and Clinical Importance of Superficial Arterial Palmar Irrigation and its Variants over 86 Cases

Analysis and Clinical Importance of Superficial Arterial Palmar Irrigation and its Variants over 86 Cases

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Published by: Nicolas Ernesto Ottone on Dec 19, 2010
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157
 Int. J. Morphol., 28(1)
:157-164, 2010.
Analysis and Clinical Importance of Superficial ArterialPalmar Irrigation and its Variants over 86 Cases
An
á
lisis e Importancia Cl
í 
nica de la Irrigaci
ó
n ArterialPalmar Superficial y sus Variaciones sobre 86 Casos
Nicol
á
s Ernesto Ottone; Natalia Prum; Mario Dominguez; Esteban Blasi;Carlos Medan; Sergio Shinzato; Diana Finkelstein & Vicente Hugo BertoneOTTONE, N. E.; PRUM, N.; DOMINGUEZ, M.; BLASI, E.; MEDAN, C.; SHINZATO, S.; FINKELSTEIN, D.; BERTONE, V.H.
Analysis and clinical importance of superficial arterial palmar irrigation and its variants over 86 cases.
 Int. J. Morphol., 28(1)
:157-164, 2010.
SUMMARY:
The classic description of the hand
s superficial palmar arch is based on the anastomosis among the ulnar andradiopalmar arteries, a branch of the radial artery. However, the arch formation is highly variable regarding the size of the arteries thatmake it up and due to the existence of branches coming from other arteries and adding up as tributary to it. The objective of this paper isto classify these possible varieties, to define the formation of the arch, the reasons for its variable arrangement and the importance of itsclinical and surgical applications. 86 formalized hands were dissected at 40%. There is prevalence concerning the size of the ulnar artery,with or without an arch. The anatomic knowledge of the variability in the arch formation becomes important in the application of surgicaltechniques that can help treating pathologies of the hand.
KEY WORDS: Superficial palmar arch; Anatomy; Anatomical variations; Hand.
INTRODUCTIONThe radial and ulnar arteries, together with othervessels, form the superficial and deep palmar arterial arches.According to the classic description (Bouchet & Cuilleret,1997; Casiraghi
et al
., 1969; Goss, 1976; Little
et al.
, 1973;Testut & Latarjet, 1954), anastomosis among the ulnar andradiopalmar arteries gives rise to the superficial palmar arch,from which the palmar digital arteries derive.Nonetheless, the formation that is considered
nor-mal
is highly variable. Kaplan (1961) believe that in 66%of cases, the superficial palmar arch is formed by the ulnarartery. The most common disposition is the ulnar arteryending in the second metacarpal space and the thumb
s twocollateral palmars and the index
s collateral radial beingsupplied by the radial artery.Furthermore, Adachi (1928) thinks that the superfi-cial palmar arch has an ulnar-prevalent formation, which hecalls the Ulnar-type and finds it in 59% of cases.On the other hand, unlike the two cited authors,Coleman & Anson (1961) developed a classification in whichthe superficial palmar arch is formed in 78.46% of cases,and consider this described arrangement as
classic
in34.5%.Therefore, the objective of this paper is to analyzethe actual formation of the superficial palmar arch, definingthe reasons for its variable arrangement, the importance of its knowledge and its clinical and surgical applications.
MATERIAL AND METHOD
A total number of 86 hands, 46 left ones and 40 rightones, were dissected and formolized at 10% with no sex orage discrimination. Because of variability it was no possibleto establish statistical significant differences. The dissection
School of Medicine, Universidad de Buenos Aires, Argentina.
 
158
technique was based on the search for the superficial pal-mar arch respecting the different planes present from thesurface to the deep part. Regular surgical instruments wereuse.
RESULTS
As seen in Figure 1, we have grouped the results onthe basis of the following classification:Type: it indicates the presence or absence of a properlyshaped vascular arch.Subtype: a subdivision of the Type arrangement indicatingwhich the tributary arteries of the superficial palmar systemare.Pattern: it determines the prevalence of the tributary arteriesof the superficial palmar system.According to our investigation, over a total amountof 86 dissected hands, we have observed a first major divisioninto two types: Arch Type and Non Arch Type.The existing Arch Type responds to the existence of an arterial system formed by the union of two arteries andwhose arrangement involves the geometric pattern wecommonly call
arch
in the strict sense. In turn, the palmardigitals that are later divided into the fingers collateralsoriginate in this arch. This arrangement was found in 50cases (58.0%).In the Non Arch Type there is no proper vascular
arch
formation. The area vascularized by the arch isreplaced by one artery (alone) or two (mutually independent)
Fig. 1. Classification of the superficialarterialpalmarirrigation.
OTTONE, N. E.; PRUM, N.; DOMINGUEZ, M.; BLASI, E.; MEDAN, C.; SHINZATO, S.; FINKELSTEIN, D.; BERTONE, V. H.
Analysis and clinical importance of superficial arterial palmarirrigation and its variants over 86 cases.
 Int. J. Morphol., 28(1)
:157-164, 2010.
 
159
arteries. Whatever the found subtype might be, they are incharge of supplying the whole superficial vascularizationfor the palm of the hand. This arrangement was found in the36 remaining cases (42.0%) out of the 86 dissectedhands.Within the existing Arch Type, there are two subtypes.Ulnar-Radiopalmar Subtype (37 cases; 43.0%): theproper arch exists and is formed by the union between theulnar and radiopalmar arteries, a branch of the radial artery.This subtype can be divided in two ways:-Ulnar Pattern (18 cases; 20.9%): the particularcharacteristic of this arrangement is that the ulnar artery hasa larger size than the radiopalmar artery (approximatelydouble its size) and, as a result, all the palmar digital arteriesare supplied by the part of the arch formed by the ulnar artery.The radiopalmar artery would participate in the
arch
formation only in its closure and by supplying some branchof minor importance at the level of the thenar muscles.- Classic Pattern (19 cases; 22.1%) (Figure 4): it refersto the arrangement described by ancient anatomists (Goss,1976; Testut & Latarjet) who believed that the superficialpalmar arch is normally formed by anastomosis among theulnar and radiopalmar arteries, both of the same size.Ulnar-Radial Subtype (13 cases; 15.0 %): Based onthe participating arteries, the arch has an antero-posterior(palmar to dorsal) arrangement. Depending on the arteryanastomosing with the ulnar (always present) artery, thissubtype can be as follows:- Ulnar + Radial
Proper
Pattern (6 cases; 7.0%):the radial artery, once it leaves its dorsal pathway, reachesthe deep palmar region when going through the upper sideof the first interosseal space anastomosing at this level withthe ulnar artery.
Fig. 2a. Ulnar + 1st Dorsal Interosseus pattern. Ua. Ulnar artery; *
crossroads
style; *1 absence of radiopalmar artery.Fig. 2b. Ulnar + 1st Dorsal Interosseus pattern. 1DI. 1st DorsalInterosseus artery; *
crossroads
style.
OTTONE, N. E.; PRUM, N.; DOMINGUEZ, M.; BLASI, E.; MEDAN, C.; SHINZATO, S.; FINKELSTEIN, D.; BERTONE, V. H.
Analysis and clinical importance of superficial arterial palmarirrigation and its variants over 86 cases.
 Int. J. Morphol., 28(1)
:157-164, 2010.

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