Welcome to International Journal of Anatomy and Research

Type of Article: Case Report

Year: 2015 | Volume 3 | Issue 4 | Page No. 1638-1641

Date of Publication: 31-12-2015

DOI: http://dx.doi.org/10.16965/ijar.2015.302

UNILATERAL INCOMPLETE SUPERFICIAL PALMAR ARCH: A CASE REPORT

Subhankar Chakraborty ¹, Subhra Mandal ^*2.

¹ 2nd yr Post-Graduate Trainee, Department of Anatomy, Medical College and Hospital, Kolkata, West Bengal, India.
^*2 Associate Professor, Department of Anatomy, Medical College and Hospital, Kolkata, West Bengal, India.

Address: Dr.(Mrs) Subhra Mandal, MD (Anatomy), Associate Professor, Medical College Kolkata, West Bengal, India. Mobile no.:+919477458100
E-Mail: drsuvramandal@gmail.com

Abstract

The functional importance of hand is revealed by its rich vascularity contributed by superficial and deep palmar arches (SPA and DPA).Superficial palmar arch is located superficial to flexor tendons, and deep palmar arch deep to lumbrical muscles. Variations are found more often in SPA than DPA, later being more or less constant. During routine undergraduate dissection, we observed, unilateral incomplete SPA being formed by superficial palmar branches of ulnar and radial artery in the right hand of a male cadaver. These two arteries remained independent without anastomosis forming incomplete arch (SPA).The superficial branch of ulnar artery entered hand superficial to flexor retinaculum and supplied middle, ring and little finger by three branches. The superficial branch of radial artery via its two branches supplied index finger and thumb. Classical SPA formation was seen on left side.
The presence of an incomplete SPA as in this case is a potential danger in RA harvesting for CABG.Variations in SPA play a pivotal role in microvascular surgical procedures of hand, RAinterventions and arterial graft applications.
KEY WORDS: Superficial palmar arch, Deep palmar arch, lumbrical , anastomosis, retinaculum, CABG, microvascular surgery.

References

1. Gajisin S, Zbrodowski A. Local vascular contribution of the superficial palmar arch. Acta Anat, 1993;147:248–251.
2. Claassen H, Schmitt O, Wree A. Large patent median arteries and their relation to the superficial palmar arch with respect to history, size consideration and clinical consequences, Surg Radiol Anat. 2008;30:57-63. Doi: 10.1007/S00276-007-0290-5
3. Agur AM, Lee MJ. Grant’s Atlas of Anatomy. 9th Ed., Philadelphia, Lippincott, Williams and Wilkins. 1999;419
4. Standring Susan. Gray's anatomy : the anatomical basis of clinical practice (40th ed.); p.894
5. Gellman H, Botte MJ, Shankwiler j, Gelberman RH. Arterial patterns of the deep and superficial palmar arches. Clin Orthop Relat Res 2001;383E:41-46.
6. Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens, Surg Gynec and Obstet. 1961;113:409-24.
7. Jelicic N, Gajisin S, Zbrodowski A. Arcus Palmaris superficialis, ActaAnat (Basel). 1988; 132:187-190.
8. Janevski BK. Angiography of the upper extremity. The Hague: Martinus Nijhoff 1982; pp.73-122.
9. Ikeda A, Ugawa A, Kazihara Y, Hamada N. Arterial patterns in the hand based on three-dimensional analysis of 220 cadaver hands. J Hand Surg Am. 1988;13A:501-9.
10. Ruengsakulrach P, Eizenberg N, Fahrer C, Fahrer M, Buxton BF (2001) Surgical implications of variations in hand collateral circulation: Anatomy revisited. J Thor Cardio Surg, 2001;122:682–686.
11. Loukas M, Holdman D, Holdman S. Anatomical variations of the superficial and deep palmar arches. Folia Morphol (Warsz) 2005;64:78-83.
12. Patnaik VVG, Kalsey G, Singla RK. Palmar Arterial Arches- A Morphological Study. J Anat Soc India 2002;51(2):187-193.
13. Al-Turk M, Metcalf WK (1984) A study of the superficial palmar arteries using the Doppler Ultrasonic Flowmeter. J Anat, 1984;138:27–32.
14. Sarkar A, Dutta S, Bal K, Biswas J. Handedness may be related to variations in palmar arterial arches in humans. Singapore Med J 2012;53:409–412.
15. Tagil SM, Cicekcibasi AE, Ogun TC, Buyukmumcu M, Salbacak A. Variations and clinical importance of the superficial palmar arch. S.D.U. Tip Fakultesi Dergisi. 2007;14: 11-16.
16. Bataineh ZM, Moqattash ST. A complex variation in the superficial palmar arch. Folia Morphol (Warsz). 2006; 65: 406–409.
17. Johnson WH 3rd, Cromartie RS 3rd, Arrants JE, Wuamett JD, Holt JB (1998). Simplified method for candidate selection for radial artery harvesting. Ann Thoracic Surgery 1998;65:1167.
18. Starnes SL, Wolk SW, Lampman RM, Shanley C., Parger RL, Kong BK, Fowler JJ, Page JM, Babcock. Noninvasive evaluation of hand circulation before radial artery harvest for coronary artery bypass grafting. Journal of Thoracic & Cardiovascular Surgery 1999;117: 261-266.

Subhankar Chakraborty, Subhra Mandal. UNILATERAL INCOMPLETE SUPERFICIAL PALMAR ARCH: A CASE REPORT. Int J Anat Res 2015;3(4):1638-1641. DOI: 10.16965/ijar.2015.302