Vojnosanitetski pregled 2022 Volume 79, Issue 7, Pages: 724-729
https://doi.org/10.2298/VSP201020014M
Full text (
466 KB)
Anatomical variations of the superficial palmar arch and its clinical relevance
Mališ Miloš (University of Belgrade, Faculty of Medicine, Institute of Anatomy “Niko Miljanić”, Belgrade, Serbia)
Kapor Slobodan 
(University of Belgrade, Faculty of Medicine, Institute of Anatomy “Niko Miljanić”, Belgrade, Serbia), kaporbg@gmail.com
Puškaš Laslo (University of Belgrade, Faculty of Medicine, Institute of Anatomy “Niko Miljanić”, Belgrade, Serbia)
Aksić Milan (University of Belgrade, Faculty of Medicine, Institute of Anatomy “Niko Miljanić”, Belgrade, Serbia)
Blagojević Valentina (University of Belgrade, Faculty of Medicine, Institute of Anatomy “Niko Miljanić”, Belgrade, Serbia)
Žarković Nikola (University of Belgrade, Faculty of Medicine, Institute of Anatomy “Niko Miljanić”, Belgrade, Serbia)
Đurašić Ljubomir (University Clinical Center of Serbia, Department of Physical Medicine and Rehabilitation, Belgrade, Serbia)
Filipović Branislav (University of Belgrade, Faculty of Medicine, Institute of Anatomy “Niko Miljanić”, Belgrade, Serbia)
Vukomanović-Đurđević Biserka (University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia + Military Medical Academy, Institute of Pathology and Forensic Medicine, Belgrade, Serbia )
Background/Aim. In-depth knowledge of the vascular net-work of the hand is of great importance in modern medicine. The main vessel of the hand is the superficial palmar arch (SPA). As typically described in anatomical textbooks, it arises as a terminal branch of the ulnar artery, which then anastomoses with the superficial palmar branch of the radial artery. However, the SPA is characterized by remarkable variability, which has been the area of interest of many researchers so far. The aim of this study was to exert a comprehensive examination of the anatomy of the SPA. Methods. The research was conducted at the Institute of Anatomy “Niko Miljanić” on a total number of 14 cadavers. After careful dissection, variations of the modality of formation of the SPA and its distance of the SPA from Kaplan’s cardinal line were observed on the right hands. Collected data were then analyzed statistically in SPSS 11.0 using the Mann-Whitney U test, with the accepted level of statistical significance of p < 0.05. Results. According to Coleman and Anson’s classification, the higher incidence of the incomplete type (57.14%) of the SPA was observed compared to the complete type (42.86%). In addition to this, a statistically significant difference was discovered in the distance of the SPA from Kaplan’s cardinal line between two groups with complete and incomplete types, respectively. The parameter examined in the group with the complete type took the value of 2.13 ± 0.32 cm, while in the group with the incomplete type measured 3.33 ± 0.87 cm. Conclusion. The present study showed a very important complexity in the domain of anatomy of the SPA with numerous clinical implications. For that reason, a thorough evaluation of the hand circulatory system should be considered while planning surgical procedures in order to avoid operative and postoperative complications.
Keywords: anatomic variation, ulnar artery, hand
Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III41020
Show references
Littler JW. The physiology and dynamic function of the hand. Surg Clin North Am 1960; 40: 259-66.
Gokhroo R, Bisht D, Gupta S, Kishor K, Ranwa B. Palmar arch anatomy: Ajmer Working Group classification. Vascular 2016; 24(1): 31-6.
Tagyl SM, Cicekcibasi AE, Ogun TC, Buyukmumcu M, Salbacak A. Variations and clinical importance of the superficial palmar arch. SDU Tip Fak Derg 2007; 14(2): 11-6.
Patnaik VVG, Kalsey G, Singla Rajan K. Palmar arterial arches - a morphological study. J Anat Soc Ind 2002; 51: 187-93.
Chirag B, Candice DM, Johnson LY, Omid RB, Kar R. Incomplete superficial palmar arch and bilateral persistent median artery. Int J Surg Case Rep 2019; 58: 205-7.
Gajisin S, Zbrodowski A. Local vascular contribution of the superficial palmar arch. Acta Anat (Basel) 1993; 147(4): 248-51.
Ilic A. Hand arteries. In: Bogdanovic D, Mrvaljevic D, editors. Anatomy of the upper extremity. Belgrade, Serbia: Faculty of Medicine, University of Belgrade; 1991. p. 66. (Serbian)
Haladaj R, Wysiadecki G, Dudkiewicz Z, Polguj M, Topol M. Persistent median artery as an unusual finding in the carpal tunnel: its contribution to the blood supply of the hand and clinical significance. Med Sci Monit 2019; 25: 32-9.
Jaschtschinski SN. Morphologie und topographie des arcus volaris sublimis und profundus. Anat Hefte 1897; 7: 163-88. (German)
Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obst 1961; 113(4): 409-24.
Ikeda A, Ugava A, Kazihara Y, Hamada N. Arterial patterns in the hand based on a three-dimensional analysis of 220 cadaver hands. Am J Hand Surg 1988; 13(4): 501-9.
Aragão JA, da Silva AC, 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(1): 107-11.
Aktouf A, Auquit-Auckbur I, Mebtouche N, Mouilhade F, Le Moulec YP, Milliez PY, et al. Anatomical study and clinical relevance of the flexor superficialis synovial flap: an assessment of 31 hand dissections. Surg Radiol Anat 2012; 34(6): 493-8.
Gellman H, Botte MJ, Shankwiler J, Gelberman RH. Arterial patterns of the deep and superficial palmar arches. Clin Orthop Relat Res 2001; (383): 41-6.
Singh S, Lazarus L, De Gama BZ, Satyapal KS. An anatomical investigation of the superficial and deep palmar arches. Folia Morphol (Warsz) 2017; 76(2): 219-25.
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(1): 181-5.
Gnanasekaran D, Veeramani R. Newer insights in the anatomy of superficial palmar arch. Surg Radiol Anat 2019; 41(7): 791-9.
Janevski BK. Anatomy of the arterial system of the upper extremities. In: Landsmeer JMF, Terpstra JL, editors. The Angi-ography of the upper extremity. Hague, Netherlands: Martinus Nijhoff 1982; p. 120.
Joshi SB, Vatsalaswamy P, Bahetee BH. Variation in formation of superficial palmar arches with clinical implications. J Clin Diagn Res 2014; 8(4): AC06-9.
Ozkus K, Peştelmaci T, Soyluoğlu AI, Akkin SM, Ozkus HI. Variations of the superficial palmar arch. Folia Morphol (Warsz) 1998; 57(3): 251-5.
Rodríguez-Niedenführ M, Sañudo JR, Vázquez T, Nearn L, Logan B, Parkin I. Median artery revisited. J Anat 1999; 195(Pt 1): 57-63.
Barfred T, Højlund AP, Bertheussen K. Median artery in carpal tunnel syndrome. J Hand Surg Am 1985; 10(6 Pt 1): 864-7.
Panchal AP, Trzeciak MA. The clinical application of Kaplan’s cardinal line as a surface marker for the superficial palmar arch. Hand 2010; 5: 155-9.
Vella JC, Hartigan BJ, Stern PJ. Kaplan’s cardinal line. J Hand Surg 2006; 31(6): 912-8.
Singer E. Embryological pattern persisting in arteries of the arm. Anat Rec 1933; 55(4): 403-9.
O’Sullivan E, Mitchell B. Association of the absence of palmaris longus tendon with an anomalous superficial palmar arch in the human hand. J Anat 2002; 201(5): 405-8.
Tan RES, Lahiri A. Vascular anatomy of the hand in relation to flaps. Hand Clin 2020; 36(1): 1-8.
Ruengsakulrach P, Eizenberg N, Fahrer C, Fahrer M, Buxton BF. Surgical implications of variations in hand collateral circula-tion: Anatomy revisited. J Thorac Cardiovasc Surg 2001; 122(4): 682-6.
Nunoo-Mensah J. An unexpected complication after harvesting of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1998; 66(3): 929-31.
Doscher W, Viswanathan B, Stein T, Margolis IB. Hemodynamic assessment of the circulation in 200 normal hands. Ann Surg 1983; 198(6): 776-9.
Lockhardt RD, Hamilton GF, Fyfe FW. Vascular system - Systemic arteries. In: Anatomy of the human body. London, United Kingdom: Faber & Faber Ltd. 1959; p. 612.