Title & Abstract

International Journal of Anatomy and Research

Mapping the Arterial Architecture of the Hand: A Cadaveric Study Using Vascular Silicone Gel Injection

DOI: 10.16965/ijar.2026.184

Quadras, Pranup Roshan ¹

David, Susie Jeyalyn ²

D'Souza, Prima Swetha ³

Chandy, Dane ⁴

¹ Department of Anatomy, AJ Institute of Medical Sciences, Mangalore, Karnataka, India.

² Department of Anatomy, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari District, Tamilnadu, India.

³ Department of Anatomy, Nitte (Deemed to be University) KS Hegde Medical Academy (KSHEMA), Mangalore, Karnataka, India.

⁴ Department of Anatomy, Father Muller Medical College, Mangalore, Karnataka, India.

ABSTRACT

Background.

The blood supply to the hand is provided by superficial palmar arch (SPA) and deep palmar arch (DPA). The knowledge of the arterial pattern is essential not only to anatomists, but also to surgeons, to carry out successful hand surgeries and to harvest radial artery (RA) as a graft for bypass surgery.

Aims and Objectives.

1. To study the major and smaller branches which are not seen during routine dissection using vascular dye injection technique. 2. To study the variation of branching pattern of these arteries and their relevance in terms of clinical implications.

Materials and Methods.

20 hands were selected randomly from 10 human cadavers. During embalming of the bodies, heparin was mixed in the embalming fluid to ensure that the vessels were cleared of clots and the lumen was patent. A flowable silicone compound (RTV116) was injected through the axillary artery and after one week, the hand specimens were dissected to expose the arches.

Results.

In the current study, out of the 20 cadaveric hands dissected, 19 hands (95%) presented with a complete SPA and 1 hand (5%) with incomplete SPA. Out of the 19 hands with complete arches, in 18 hands (94.7%), the SPA was formed by the radial and ulnar arteries. While in 1 hand (5.3%), the SPA was formed by ulnar artery alone. The hand with an incomplete SPA exhibited a radio-ulnar pattern. Different SPA patterns were observed in the same cadaver. Two cadavers, in the present study, showed this phenomenon. In one cadaver, the right hand had a complete SPA of Type B and the left hand had a complete SPA of Type A. In another cadaver, the right hand had an incomplete SPA of Type F and the left hand had a complete SPA of Type A.

Conclusion.

The use of RTV 116 via vascular injection technique was beneficial to visualize the arch along with its minute branches and carry out meticulous dissection. Few variations and asymmetry with regards to SPA were observed.

Keywords: Superficial palmar arch; Deep palmar arch; Radial artery; Vascular injection technique

INTRODUCTION

The hand is the most complex part of the human body, involved in skilled movements and fine handling of objects. The human hand can be easily modulated to carry out certain compound movements with great precision, as per our need. Complex skilled movements require the hand to be placed and held in various anatomical positions. As a result, the entire framework of the human hand is supplied with an abundance of highly branched and anastomosing arteries which provides adequate blood supply [1,2].

The earliest evidence of anatomical study on the vascular system of the hand dates back to the 16th century. Andreas Vesalius, in his publication, 'De Humani Corporis Fabrica' described the arterial supply of the hand. However, in his study, he did not specifically mention the presence of superficial and deep palmar arches. In 1961, Coleman and Anson [1] reported the presence of superficial and deep palmar arches in a study carried out on 650 cadavers. Furthermore, this was also later confirmed by Gellman et al., wherein they stated that both arterial arches were present in all their cases [2].

The arterial supply of the hand is by both, ulnar and radial arteries. The terminal parts of the ulnar and radial arteries on reaching the palmar aspect of the hand anastomose with each other to form superficial and deep palmar arches. The superficial branch remains to be a direct continuation of ulnar artery and forms the main contribution of the superficial palmar arch (SPA). The arch is eventually completed by one of the branches of the radial artery. The superficial palmar arch then gives four branches. One of which happens to be a proper branch to the little finger medially, and the other three are common digital arteries. These common digital arteries then further subdivide in pairs along the web spaces to form the proper palmar digital arteries. These all put together supply the medial three and a half fingers of the hand [3].

The human hand is supplied mainly by the superficial palmar arch (SPA) and deep palmar arch (DPA). The SPA forms a vascular arcade across the palm. The SPA can be classified into 'complete' and 'incomplete' SPA, depending on the presence or absence of anastomosis between the vessels forming the SPA [2]. The most classical form of SPA is the 'complete radio-ulnar' type, which is usually formed between the superficial branch of ulnar artery and is completed by a branch of the radial artery [1].

Anatomical variations have been observed with SPA and its contributing arteries which have been reported in literature [4,5]. It has been suggested that certain regulatory factors like hemodynamic forces, availability of oxygen and nutrient requirements during angiogenesis play a role in determining the arterial pattern at the time of foetal development. It should be also noted that the arterial patterns are highly reproducible and therefore genetic basis for the occurrence of such variations should not be undermined [6].

With the advent of microvascular surgeries for revascularization of the hand, replantations, grafting of various parts of the limbs and correcting deformities, knowledge of the arterial variations of the hand is essential for carrying out successful hand surgeries. More recently, radial arterial grafts are being used in bypass surgeries. The presence of a complete palmar arch and its proper identification are necessary in order to extract the radial artery [7]. Although there are many previous studies on SPA, they are most often done on dissected embalmed cadavers which make it hard to distinguish the minute branches of SPA. To bridge the gap, the present study aims in executing a meticulous dissection to find out the frequency of variations in SPA patterns using coloured silicone gel injection technique.

MATERIALS AND METHODS

Aims and Objectives

The aim of the study is not only to study the major branches but also the smaller branches which are not seen during routine dissection using vascular injection technique, and to study the variation of branching pattern of these arteries and their relevance in terms of clinical implications.

Materials, Study Design, and Sample Size

This was a cross-sectional study conducted in the Department of Anatomy, K.S. Hegde Medical Academy, following ethical clearance from the Institutional Ethical Committee. Twenty hands were selected from randomly chosen 10 human cadavers (both male and female). Specimens with gross pathology, damage, missing fingers, or congenital anomalies were excluded. Materials used included a standard dissection kit, flowable silicone dye (RTV 116, Momentive Performance Materials), ligatures, 50 mL syringes, cannulas, magnifier, and handheld digital camera (Figures 1 and 2).

Vascular Injection and Dissection Procedure

During embalming, a separate vial of Heparin (25,000 IU) was mixed with the embalming fluid (10% formalin with glycerine and thymic granules) to clear the vessels of blood clot remnants and ensure luminal patency. Dissection followed Cunningham's Manual of Practical Anatomy [8]. The axillary artery distal to the pectoralis minor muscle was cannulated, and approximately 50 mL of red flowable silicone compound (RTV 116) was injected. The proximal axillary artery was ligated, and specimens were kept for seven days to allow silicone vulcanization/hardening. After one week, meticulous palmar dissection was carried out to trace the superficial and deep palmar arches and their digital branches (Figure 3, 4, 5).

Figure 3

RESULTS

The patterns of the superficial palmar arch were categorized based on the classification established by Coleman and Anson [1] (Table 1).

Out of the 20 dissected hands, 19 hands (95%) exhibited a complete superficial palmar arch (Group I), while 1 hand (5%) presented an incomplete arch (Group II). Among the 19 complete arches, 18 hands (94.7%) were Type A (classical radio-ulnar arch, Figure 3), and 1 hand (5.3%) was Type B (ulnar-derived arch, Figure 4). The single incomplete arch was Type F (non-anastomosing radio-ulnar type, Figure 5) (Table 2).

Figure 4

Figure 5

Bilateral asymmetry was noted in two cadavers: in one cadaver, the right hand had a complete SPA of Type B and the left hand had Type A; in another cadaver, the right hand had an incomplete SPA of Type F and the left hand had a complete SPA of Type A.

Table 1

Coleman and Anson's classification of Superficial Palmar Arch [1].

Type | Description
Group I | Complete arch
Type A | Classical radio-ulnar arch, formed by superficial palmar branch of radial artery and ulnar artery
Type B | Formed by ulnar artery alone
Type C | Mediano-ulnar arch-composed of ulnar artery and median artery
Type D | Radio-mediano-ulnar arch
Type E | Arch is initiated by ulnar artery and completed by a large sized vessel from the deep palmar arch
Group II | Incomplete arch
Type F | Formed by both superficial palmar branch of radial artery and ulnar artery and do not anastomose
Type G | Only ulnar artery forms the superficial palmar arch but the arch is still incomplete
Type H | Median and ulnar artery contribute but do not anastomose
Type I | Radial, median and ulnar artery play a role but fail to anastomose

Table 2

Distribution of Superficial Palmar Arch patterns across specimens.

Specimen No. | Sex | Side | Pattern Group | Type
1 | Male | Right | Group I | A
2 | Male | Left | Group I | A
3 | Male | Right | Group I | A
4 | Male | Left | Group I | A
5 | Male | Right | Group I | A
6 | Male | Left | Group I | A
7 | Male | Right | Group I | A
8 | Male | Left | Group I | A
9 | Male | Right | Group I | B
10 | Male | Left | Group I | A
11 | Female | Right | Group I | A
12 | Female | Left | Group I | A
13 | Male | Right | Group I | A
14 | Male | Left | Group I | A
15 | Male | Right | Group II | F
16 | Male | Left | Group I | A
17 | Female | Right | Group I | A
18 | Female | Left | Group I | A
19 | Male | Right | Group I | A
20 | Male | Left | Group I | A

DISCUSSION

The human hand is endowed with a rich anastomotic network mainly contributed by the superficial palmar arch and deep palmar arch [1,2]. The 95% prevalence of complete arches observed in the present study closely matches previous reports by Jose et al. (96%) [9], Suma et al. (95%) [10], Ramakrishnan et al. (92%) [8], Bilge et al. (86%) [12], and Joshi et al. (82%) [11] (Table 3), while contrasting with series reporting higher incomplete arch frequencies (e.g., Sarkar et al. 55% [13], Fazan et al. 52% [14], Valeria et al. 47.5% [15], and Sullivan & Mitchell 46.8% [16]).

In terms of subtypes, the classical radio-ulnar Type A predominated (90.0% overall, 94.7% of complete arches), corroborating Madhyastha et al. (93.75%) [17] and Suma et al. (95%) [10]. The non-anastomosing radio-ulnar Type F was the most frequent incomplete variant. Bilateral asymmetry in two cadavers confirms observations by Bilge et al. [12].

Clinical implications of these vascular variants are substantial. Free arterial anastomosis ensures rapid collateral healing but creates severe hemorrhagic risk during palmar incisions or drainage of localized pus [18]. Knowledge of arch completeness is imperative prior to radial artery harvesting in coronary artery bypass grafting (CABG) or during reconstructive microvascular limb and hand surgery [7].

Table 3

Comparison of SPA prevalence with previous studies.

Contributors | Year | No. of hands (Sample size) | Complete arch (%) | Incomplete arch (%)
Coleman and Anson [1] | 1961 | 650 | 78.5 | 21.5
Patnaik et al [4] | 2001 | 50 | 78 | 16
Loukas et al [7] | 2005 | 200 | 78 | 16
Bilge et al [12] | 2006 | 50 | 86 | 14
Joshi et al [11] | 2014 | 100 | 82 | 18
Ramakrishnan et al [8] | 2014 | 50 | 92 | 8
Suma et al [10] | 2014 | 20 | 95 | 5
Jose et al [9] | 2017 | 69 | 96 | 4
Present study | 2026 | 20 | 95 | 5

Table 4

Comparison of subtypes with previous studies.

Study | Sample Size | Complete: A (%) | B (%) | C (%) | D (%) | E (%) | Incomplete: F (%) | G (%) | H (%) | I (%)
Coleman and Anson [1] | 650 | 34.5 | 37 | 3.8 | 1.2 | 2 | 3.2 | 13.4 | 3.8 | 1.1
Patnaik et al [4] | 50 | 76 | 2 | - | - | - | 12 | - | 4 | -
Loukas et al [7] | 2005 | 40 | 35 | 15 | 6 | 4 | - | - | - | -
Bilge et al [12] | 50 | 86 | - | - | - | - | 14 | - | - | -
Ramakrishnan et al [8] | 50 | 86 | 6 | - | - | - | 6 | - | 2 | -
Joshi et al [11] | 100 | 4 | 56 | - | - | - | 22 | 4 | 10 | 4
Madhyastha et al [17] | 48 | 93.75 | 2.08 | - | - | - | 2.08 | - | - | -
Suma et al [10] | 20 | 95 | - | - | - | - | 5 | - | - | -
Jose et al [9] | 69 | 39 | 17 | 9 | - | - | 31 | - | 4 | -
Present study | 20 | 90 | 5 | - | - | - | 5 | - | - | -

CONCLUSION

The use of RTV 116 silicone compound via vascular injection technique facilitated clear visualization of the superficial palmar arch and its fine digital ramifications. A high prevalence of complete arches (95%), predominantly of classical radio-ulnar Type A (90%), was identified alongside instances of bilateral anatomical asymmetry. Detailed appreciation of palmar arterial variations is essential for safe hand surgery, pus drainage, and radial artery graft harvesting.

Abbreviations & Declarations

DECLARATIONS

Ethical Approval: The study was approved by the Institutional Ethical Committee of K.S. Hegde Medical Academy.

Conflicts of Interest: None.

Author Contributions: Pranup Roshan Quadras: Effective scientific and intellectual participation, technical procedures, data acquisition, data interpretation, manuscript preparation and draft, final approval. Susie Jeyalyn David: Effective participation, technical procedures, data interpretation, manuscript preparation, statistical analysis, final approval. Prima Swetha D'Souza: Effective participation, technical procedures, data acquisition, manuscript drafting, final approval. Dane Chandy: Effective participation, technical procedures, data acquisition, manuscript drafting, final approval.

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