Formation and branching patterns of deep palmar arch

Abstract

Objective: The present study is to document and provide information about both normal and variable morphology of the deep palmar arch (DPA) in adult human cadavers by the dissection method. Materials and Methods: We examined 12 upper extremities (6 cadavers). After the classification of the vascular patterns of DPA and its branches, measurements of the vessel diameters were carried out using a digital compass. Results: Deep palmar arch was found as a completed arch (100%) in all cases. The anastomosis between the distal deep palmar branch of the ulnar artery (DPBUA) and the terminal branch of the radial artery (RA) was the most common type in our study. The incidence of the DPA was reported as a complete arch ranging from 54.9% to 100%. Palmar metacarpal arteries (MPAs) originating from the DPA were divided into four branches (25%) in three cases and three branches (75%) in nine cases. The mean diameter of the MPAs at the point of origin at the DPA was between 0.3 mm and 0.6 mm. Conclusion: A comprehensive understanding of the DPA branching diameters in the hand will facilitate surgical and radiological approaches and contribute to a constantly expanding knowledge base in literature.

Keywords

• Anatomy
• Deep palmar arch
• Hand
• Radial artery
• Ulnar artery

References

1. [1] Gokhroo R, Bisht D, Gupta S, Kishor K, Ranwa B. Palmar arch anatomy: ajmer working group classification. Vascular 2016;24:31-6. doi: 10.1177/170.853.8115576428.
2. [2] Joshi SB, Vatsalaswamy P, Bahetee BH. Variation in formation of superficial palmar arches with clinical implications. J Clin Diagn Res 2016;8:6-9. doi: 10.7860/JCDR/2014/7078.4252
3. [3] Saha A, Lal N, Pal S. The superficial palmar arch: A morphological study. Int J Anat Res 2019;7:6918-23. doi: 10.16965/ijar.2019.256
4. [4] Suman U, Jayanthi KS. A study of complete superficial palmar arches formed entirely by ulnar artery. J Anat Soc India, 2011;60:199-201. doi.org/10.1016/S0003-2778(11)80026-2
5. [5] Zarzecki MP, Popieluszko P, Zayachkowski A, Pękala PA, Henry BM, Tomaszewski KA. The surgical anatomy of the superficial and deep palmar arches: a Meta-analysis. J Plast Reconstr Aesthet Surg 2018;71:1577-92. doi: 10.1016/j. bjps.2018.08.014
6. [6] Yıldırım M, Resimli Sistematik Anatomi: Istanbul: Nobel Tıp Kitabevleri, 2013:363.
7. [7] Singh S, Lazarus L, De Gama BZ, Satyapal KS. An anatomical investigation of the superficial and deep palmar arches. Folia Morphol (Warsz) 2017;76:219-25. doi: 10.5603/ FM.a2016.0050
8. [8] Patil J, Kumar N, Aithal AP, Swamy RS, Rao KGM. An eccentric anatomical variation of palmar vascular pattern: Report of surgical challenging vascular variation. J Med Sci 2016:36:240-2. doi: 10.4103/1011-4564.196372

9. [9] McLean KM, Sacks JM, Kuo YR, Wollstein R, Rubin JP, Andrew Lee WP. Anatomical landmarks to the superficial and deep palmar arches. Plast Reconstr Surg 2008;121:181-5. doi: 10.1097/01.prs.000.029.3863.45614.f9
10. [10] Bilge O, Pinar Y, Özer MA, Gövsa FA. Morphometric study on the superficial palmar arch of the hand. Surg Radiol Anat 2006;28:343-50. doi: 10.1007/s00276.006.0109-9
11. [11] Coleman S, Anson J. Arterial pattern in handbased upon a study of 650 specimens. Surg Gynaecol Obstet 1961;113:409- 24.
12. [12] Anitha T, Kalbande S, Dombe D, Asha K, Jayasree N. Variations in the formation of superficial palmar arch and its clinical significance in hand surgeries. Int J Biol Med Res 2011;2:543-6.
13. [13] Rodriguez-Niedenführ M, Vazguez T, Parkin IG, Sanudo JR. Arterial patterns of the human upper limb: update of anatomical variations and embryological development. Eur J Anat 2003;7:21-8.
14. [14] Rauch D, Fischer C, Achenbach S, Klose KJ, Wagner HJ. Angiography detection of closed palmar arcs. Rofo 1999;171:207-10.
15. [15] Loukas M, Holdman D, Holdman S. Anatomical variations of superficial and deep palmar arches. Folia Morphol 2005;64:78- 83.
16. [16] Patnaik VVG, Kalsey G, Singla-Rajan K. Palmar arterial arches-A morphological study. J Anat Soc India 2002;51:187- 93.
17. [17] van Leeuwen MAH, Hollander MR, van der Heijden DJ, et al. The ACRA anatomy study (assessment of disability after coronary procedures using radial access): a comprehensive anatomic and functional assessment of the vasculature of the hand and relation to outcome after transradial catheterization. Circ Cardiovasc Interv 2017;10:e005753. doi: 10.1161/ CIRCINTERVENTIONS.117.005753
18. [18] Gellman H, Botte MJ, Shankwiler J, Gelberman R. Arterial patterns of the deep and superficial palmar arches. Clin Orthop Relat Res 2001;383:41-6.
19. [19] Ghuran AV, Dixon G, Holmberg S, de Belder A, Hildick-Smith D. Transradial coronary intervention without pre-screening for a dual palmar blood supply. Int J Cardiol 2006;121:320-2. doi: 10.1016/j.ijcard.2006.11.009
20. [20] Hollander MR, van Leeuwen MA, van der Heijden DJ, et al. Non-invasive assessment of the collateral circulation in the hand: validation of the nexfin system and relation to clinical outcome after transradial catheterisation. EuroIntervention 2017;12:1773-81. doi: 10.4244/EIJ-D-16-00337.
21. [21] Tanzilli G, Truscelli G, Barillà F, et al. Evaluation of hand circulation with cardiowaves photoplethysmograph device during allen test in healthy volunteers. Eur Rev Med Pharmacol Sci 2015;19:3006-11.
22. [22] Bigler MR, Buffle E, Siontis GCM, et al. Invasive assessment of the human arterial palmar arch and forearm collateral function during transradial access. Circ Cardiovasc Interv 2019;12:e007744.
23. [23] Dhar P, Lall K. An atypical anatomical variation of palmar vascular pattern. Singapore Med J 2008;49:245.
24. [24] Bilge O, Özer MA, Pınar Y, Gövsa F. Deep palmar arch in Man. Türkiye Klinikleri J Med Sc 2009;29:816-20.
25. [25] Olave E, Prates JC. Deep palmar arch pattern in Brazilian individuals. Surg Radiol Anat 1999;21:267-71.
26. [26] Bini N, Leclercq C. Anatomical study of the deep branch of the ulnar nerve and application to selective neurectomy in the treatment of spasticity of the first web space. Surg Radiol Anat 2020;42:253-8. doi: 10.1007/s00276.019.02380-y
27. [27] Gil YC, Shin KJ, Lee SH, Koh KS, Song WC. Anatomy of the deep branch of the ulnar nerve. J Hand Surg (European Volume) 2016;41:1-5. doi: 10.1177/175.319.3415622188
28. [28] Wynter S, Dissabandara L. A comprehensive review of motor innervation of the hand: variations and clinical significance. Surg Radiol Anat 2018;40:259-69. doi: 10.1007/ s00276.017.1898-8
29. [29] Sulaiman S, Soames R, Lamb C. Ulnar nerve cutaneous distribution in the palm: application to surgery of the hand. Clin Anat 2015;28:1022-8. doi: 10.1002/ca.22626
30. [30] Aragão JA, da Silva ACF, Anunciação CB, Reis FP. Median artery of the forearm in human fetuses in northeastern Brazil: anatomical study and review of the literature. Anat Sci Int 2017;92:107-11. doi: 10.1007/s12565.015.0322-x