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Variations and Clinical Importance of the Superficial Palmar Arch

Year 2007, Volume: 14 Issue: 2, 11 - 16, 30.04.2009

Abstract

SüleymanDemirel Üniversitesi
TIP FAKÜLTESİ DERGİSİ: 2007 Haziran; 14(2)










Variations and Clinical Importance of the Superficial Palmar Arch



Süleyman Murat Tağıl *, Aynur Emine Çiçekcibaşı **, Tunç Cevat Öğün***, Mustafa Büyükmumcu**, Ahmet Salbacak**



* Department of Anatomy, Medical Faculty, Süleyman Demirel University, Isparta, Turkey

** Department of Anatomy, Meram Medical Faculty, Selcuk University, Konya, Turkey

***Department of Orthopedics and Traumatology, Meram Medical Faculty, Selcuk University, Konya, Turkey





Özet



Arcus palmaris superficialis'in varyasyonları ve klinik önemi



Amaç: Bu çalışmanın amacı eldeki arcus palmaris superficialis (APS)'in varyasyonlarını tespit etmek ve anormal APS ile m. palmaris longus (MPL) kasının yokluğu arasındaki ilişkiyi ortaya koymaktır. Gereç ve yöntem: Çalışmamızda a. brachialis'lerinden kırmızı ile renklendirilmiş lateks ile doldurulmuş 20 kadavra eli diseke edilmiştir. Eldeki damarsal varyasyonlar ve MPL kasının varlığı veya yokluğu kaydedilerek fotoğraflanmıştır. Bulgular: APS'ler 15 elde (%75) komplet, 5 elde (%25) ise inkomplet olarak tespit edildi. APS'inde varyasyon bulunan ellerin %33'ünde MPL kasının bulunmadığı görüldü. MPL'u bulunmayan ellerin tümünde aponeurosis palmaris bulunmaktaydı. Sonuç: Arteryel onarımlar, damar greft uygulamaları ve a. radialis veya a. ulnaris bazlı pediküllü veya serbest flep uygulamaları gibi rekonstrüktif el cerrahisi prosedürleri öncesinde elin vasküler yapısı ortaya konulmalıdır.



Anahtar kelimeler: Anatomi, Varyasyon, Arcus palmaris superficialis, M. palmaris longus.





Abstract



Objectives: The aim of this study was to provide an assessment of the anatomic variations of the superficial palmar arch (SPA) in the hand and to establish a correlation between an anomalous SPA and the absence of palmaris longus muscle (PL). Methods: Twenty conserved cadaver hands were dissected after latex solution colored with red ink had been injected into the vessels from the brachial artery. The vascular variations and the presence and absence of the PL were recorded and photographed. Results: The SPA was complete in 15 (75%) and incomplete in 5 (25%) of the hands. The palmaris longus tendon was absent in 33.3% of the hands with the variational SPA. We observed that in all hands without PL, the palmar aponeurosis existed.

Conclusion: The vascular patterns of the hand may documented before reconstructive hand surgical procedures such as, arterial repairs, vascular graft applications, and free and/or pedicled flaps depending on radial or ulnar artery.



Key words: Anatomy; Variation; Superficial palmar arch; Palmaris longus muscle

References

  • Gajisin S, Zbrodowski A. Local vascular contribution of the superficial palmar arch. Acta. Anat 1993; 147: 248-251.
  • Parks BJ, Arbelaez J, Horner RL. Medical and surgical importance of the arterial blood supply of the thumb. J Hand Surg [Am] 1978; 3: 383-385.
  • Pierer G, Steffan J, Holflehner H. The vascular blood supply of the second metacarpal bone: anatomic basis for a new vascularized bone graft in hand surgery. An anatomical study in cadavers. Surg Radiol Anat 1992; 14: 103-112.
  • Richards RS, Dowdy P, Roth JH. Ulnar artery palmar to palmar brevis: cadaveric study and three case reports. J Hand Surg [Am] 1993; 18: 888-892.
  • Khan K, Riaz M, Small JO. The use of the second dorsal metacarpal artery for vascularized bone graft. An anatomical study. J Hand Surg [Br] 1998; 23: 308-310.
  • Al-Turk M, Metcalf WK. A study of the superficial palmar arteries using the Doppler Ultrasonic Flowmeter. J Anat 1984; 138: 27-32.
  • Starnes SL, Wolk SW, Lampman RM, Shanley C ., Prager RL, Kong BK, Fowler JJ, Page JM, Babcock SL, Lange LA, Erlandson EE, Whitehouse WM. Noninvasive evaluation of hand circulation before radial artery harvest for coronary artery bypass grafting. J Thorac Cardiovasc Surg 1999; 117: 261-266.
  • Ruengsakulrach P, Eizenberg N, Fahrer C, Fahrer M, Buxton BF. Surgical implications of variations in hand collateral circulation: Anatomy revisited. J Thorac Cardiovasc Surg 2001; 122: 682-686.
  • Coleman SS, Anson BJ. Arterial patterns in the hand based upon the study of 650 specimens. Surg Gynecol Obstet 1961; 113: 409-424.
  • Ikeda A, Ugawa A, Kazihara Y, Hamada N. Arterial patterns in the hand based on a three-dimensional analysis of 220 cadaver hands. J Hand Surg 1988; 13: 501-509.
  • Tountas CHP, Bergman RA. Anatomic variations of the upper extremity. Churchill Livingstone, New York. 1993; pp. 200-210.
  • Olave E, Prates JC, Gabrielli C, Pardi P. Median artery and superficial palmar branch of the radial artery in the carpal tunnel. Scand J Plast Reconstr Hand Surg 1997; 31: 13-16.
  • Onderoglu S, Basar R, Erbil KM, Cumhur M. Complex variation of the superficial palmar arch – Case report. Surg Radiol Anat 1997; 19: 123-125.
  • Ozkus K, Peþtelmaci T, Soyluoglu AI, Akkin SM, Ozkus HI. Variations of the superficial palmar arch. Folýa Morphol 1998; 57: 251-255.
  • Erbil M, Aktekin M, Denk CC, Önderoglu S, Sürücü HS. Arteries of the thumb originating from the superficial palmar arch: five cases. Surg Radiol Anat 1999; 21: 217-220.
  • Bianchi H. Anatomy of the radial branches of the palmar arch. Variations and surgical importance. Hand Clin 2001; 17: 139-146.
  • Gellman H, Botte MJ, Shankwiler J, Gelberman RH. Arterial patterns of the deep and superficial palmar arches. Clin Orthop Relat Res 2001; 383Ê: 41-46.
  • Fazan VPS, Borges CT, Silva JH, Caetano AG, Filho OAR. Superficial palmar arch: an arterial diameter study. J Anat 2004; 204: 307-311.
  • Doscher W, Viswanathan B, Stein T, Margolis IB. Hemodynamic assessment of the circulation in 200 normal hands. Ann Surg 1983; 198: 776-779.
  • Janevski BK. Angiography of the upper extremity. The Hague: Martinus Nijhoff 1982; pp. 73-122.
  • Jelicic N, Gajisin S, Zbrodowski A. Arcus palmaris superficialis. Acta Anat 1988; 132: 187-190.
  • Celik HH, Sargon MF, Yilmaz E, Kayikcioglu A. Bitendinous palmaris longus muscle. Bull Assoc Anat 1996; 80: 15-16.
  • Koo CC, Roberts AH. The palmaris longus tendon. Another variations in its anatomy. J Hand Surg [Br] 1997; 22: 138-139.
  • Yildiz M, Sener M, Aynaci O. Three-headed reversed palmaris longus muscle: a case report and review of the literature. Surg Radiol Anat 2000; 22: 217-219.
  • Thompson NW, Mockford BJ, Cran GW. Absence of the palmaris longus muscle: a population study. Ulster Med J 2001; 70: 22-24.
  • Troha F, Baibak GJ, Kelleher JC. Frequency of the palmaris longus tendon in North American Caucasians. Ann Plast Surg 1990; 25: 477-478.
  • O’Sullivan E, Mitchell BS. Association of the absence of palmaris longus tendon with an anomalous superficial palmar arch in the human hand. J Anat 2002; 201: 405-408.
  • Caughell KA, McFarlane RM, McGrouther DA, Martin AH. Developmental anatomy of the palmar aponeurosis and its relationship to the palmaris longus tendon. J Hand Surg [Am] 1988; 13: 485-493.
Year 2007, Volume: 14 Issue: 2, 11 - 16, 30.04.2009

Abstract

References

  • Gajisin S, Zbrodowski A. Local vascular contribution of the superficial palmar arch. Acta. Anat 1993; 147: 248-251.
  • Parks BJ, Arbelaez J, Horner RL. Medical and surgical importance of the arterial blood supply of the thumb. J Hand Surg [Am] 1978; 3: 383-385.
  • Pierer G, Steffan J, Holflehner H. The vascular blood supply of the second metacarpal bone: anatomic basis for a new vascularized bone graft in hand surgery. An anatomical study in cadavers. Surg Radiol Anat 1992; 14: 103-112.
  • Richards RS, Dowdy P, Roth JH. Ulnar artery palmar to palmar brevis: cadaveric study and three case reports. J Hand Surg [Am] 1993; 18: 888-892.
  • Khan K, Riaz M, Small JO. The use of the second dorsal metacarpal artery for vascularized bone graft. An anatomical study. J Hand Surg [Br] 1998; 23: 308-310.
  • Al-Turk M, Metcalf WK. A study of the superficial palmar arteries using the Doppler Ultrasonic Flowmeter. J Anat 1984; 138: 27-32.
  • Starnes SL, Wolk SW, Lampman RM, Shanley C ., Prager RL, Kong BK, Fowler JJ, Page JM, Babcock SL, Lange LA, Erlandson EE, Whitehouse WM. Noninvasive evaluation of hand circulation before radial artery harvest for coronary artery bypass grafting. J Thorac Cardiovasc Surg 1999; 117: 261-266.
  • Ruengsakulrach P, Eizenberg N, Fahrer C, Fahrer M, Buxton BF. Surgical implications of variations in hand collateral circulation: Anatomy revisited. J Thorac Cardiovasc Surg 2001; 122: 682-686.
  • Coleman SS, Anson BJ. Arterial patterns in the hand based upon the study of 650 specimens. Surg Gynecol Obstet 1961; 113: 409-424.
  • Ikeda A, Ugawa A, Kazihara Y, Hamada N. Arterial patterns in the hand based on a three-dimensional analysis of 220 cadaver hands. J Hand Surg 1988; 13: 501-509.
  • Tountas CHP, Bergman RA. Anatomic variations of the upper extremity. Churchill Livingstone, New York. 1993; pp. 200-210.
  • Olave E, Prates JC, Gabrielli C, Pardi P. Median artery and superficial palmar branch of the radial artery in the carpal tunnel. Scand J Plast Reconstr Hand Surg 1997; 31: 13-16.
  • Onderoglu S, Basar R, Erbil KM, Cumhur M. Complex variation of the superficial palmar arch – Case report. Surg Radiol Anat 1997; 19: 123-125.
  • Ozkus K, Peþtelmaci T, Soyluoglu AI, Akkin SM, Ozkus HI. Variations of the superficial palmar arch. Folýa Morphol 1998; 57: 251-255.
  • Erbil M, Aktekin M, Denk CC, Önderoglu S, Sürücü HS. Arteries of the thumb originating from the superficial palmar arch: five cases. Surg Radiol Anat 1999; 21: 217-220.
  • Bianchi H. Anatomy of the radial branches of the palmar arch. Variations and surgical importance. Hand Clin 2001; 17: 139-146.
  • Gellman H, Botte MJ, Shankwiler J, Gelberman RH. Arterial patterns of the deep and superficial palmar arches. Clin Orthop Relat Res 2001; 383Ê: 41-46.
  • Fazan VPS, Borges CT, Silva JH, Caetano AG, Filho OAR. Superficial palmar arch: an arterial diameter study. J Anat 2004; 204: 307-311.
  • Doscher W, Viswanathan B, Stein T, Margolis IB. Hemodynamic assessment of the circulation in 200 normal hands. Ann Surg 1983; 198: 776-779.
  • Janevski BK. Angiography of the upper extremity. The Hague: Martinus Nijhoff 1982; pp. 73-122.
  • Jelicic N, Gajisin S, Zbrodowski A. Arcus palmaris superficialis. Acta Anat 1988; 132: 187-190.
  • Celik HH, Sargon MF, Yilmaz E, Kayikcioglu A. Bitendinous palmaris longus muscle. Bull Assoc Anat 1996; 80: 15-16.
  • Koo CC, Roberts AH. The palmaris longus tendon. Another variations in its anatomy. J Hand Surg [Br] 1997; 22: 138-139.
  • Yildiz M, Sener M, Aynaci O. Three-headed reversed palmaris longus muscle: a case report and review of the literature. Surg Radiol Anat 2000; 22: 217-219.
  • Thompson NW, Mockford BJ, Cran GW. Absence of the palmaris longus muscle: a population study. Ulster Med J 2001; 70: 22-24.
  • Troha F, Baibak GJ, Kelleher JC. Frequency of the palmaris longus tendon in North American Caucasians. Ann Plast Surg 1990; 25: 477-478.
  • O’Sullivan E, Mitchell BS. Association of the absence of palmaris longus tendon with an anomalous superficial palmar arch in the human hand. J Anat 2002; 201: 405-408.
  • Caughell KA, McFarlane RM, McGrouther DA, Martin AH. Developmental anatomy of the palmar aponeurosis and its relationship to the palmaris longus tendon. J Hand Surg [Am] 1988; 13: 485-493.
There are 28 citations in total.

Details

Primary Language English
Journal Section Research Articles
Authors

Süleyman Tağıl

Aynur Çiçekçibaşı This is me

Tunç Öğün This is me

Mustafa Büyükmumcu This is me

Ahmet Salbacak This is me

Publication Date April 30, 2009
Submission Date April 30, 2009
Published in Issue Year 2007 Volume: 14 Issue: 2

Cite

Vancouver Tağıl S, Çiçekçibaşı A, Öğün T, Büyükmumcu M, Salbacak A. Variations and Clinical Importance of the Superficial Palmar Arch. Med J SDU. 2009;14(2):11-6.

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