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Palmar Type of Median Artery as a Source of Superficial Palmar Arch: A Cadaveric Study with Its Clinical Significance

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HAND

Abstract

The superficial palmar arch (SPA) and its contributing arteries are highly variable. The palmar type of median artery (PMA) can be involved in the formation of the SPA by replacing the superficial palmar branch of the radial artery (RA) or the ulnar artery (UA). The present study was undertaken to investigate the presence of the PMA and its contribution in the formation of SPA in 42 cadavers (84 upper limbs) of Indian origin. When there was a PMA, its outer diameter was measured in the carpal tunnel. The PMA was found in 13 upper limbs (15.4%), and of these ten incidences (11.9%), the PMA took part in the formation of SPA, and in three instances (3.5%), the PMA did not make up part of the SPA. Out of the ten cases in which the PMA contributed to the formation of SPA, in six cases (7.1%), the PMA anastomosed with the UA; in three cases (3.5%), the PMA anastomosed with both the UA and the RA, and in one incidence (1.1%), the PMA joined the arteria radialis indicis (deep branch of the RA) to complete the SPA. The outer diameters of the median arteries varied between 0.8 and 2.6 mm with the mean value of 1.7 mm. The present study concludes that the median–ulnar type of SPA was the most common type of SPA when the PMA was encountered as a source of superficial arterial arcade of the hand, followed by the radial–median–ulnar type. The vascular patterns found in this study are important to hand surgeons. The present study of PMA origin, course, and its contribution to the SPA will add to the existing knowledge of the vascular anatomy of forearm and hand.

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References

  1. Acarturk TO, Tuncer U, Aydogan LB, Dalay AC. Median artery arising from the radial artery: its significance during harvest of a radial forearm free flap. J Plast Reconstr Aesthet Surg. 2008;6:e5–e8.

    Google Scholar 

  2. Al-Turk M, Metcalf WK. A study of the superficial palmar arteries using the Doppler Ultrasonic Flow meter. J Anat. 1984;138:27–32.

    PubMed  Google Scholar 

  3. Balakrishnan C, Emanuele JA, Smith FM. Asymptomatic persistent median artery in a trauma patient. Injury. 1997;28:697–8. doi:10.1016/S0020-1383(97)00085-5.

    Article  CAS  PubMed  Google Scholar 

  4. Balakrishnan C, Smith MF, Puri P. Acute carpal tunnel syndrome from thrombosed persistent median artery. J Emerg Med. 1999;17:437–9. doi:10.1016/S0736-4679(99)00011-6.

    Article  CAS  PubMed  Google Scholar 

  5. Barfred T, Hojlund AP, Bertheussen K. Median artery in carpal tunnel syndrome. J Hand Surg Am. 1985;10:864–7.

    CAS  PubMed  Google Scholar 

  6. 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 clinic consequences. Surg Radiol Anat. 2008;30:57–63. doi:10.1007/s00276-007-0290-5.

    Article  PubMed  Google Scholar 

  7. Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecand Obstet. 1961;113:409–24.

    CAS  Google Scholar 

  8. D’Costa S, Narayana K, Narayana P, Jiji NSR, Madhan SJ. Occurrence and fate of palmar type of median artery. ANZ J Surg. 2006;76:484–7. doi:10.1111/j.1445-2197.2006.03758.x.

    Article  PubMed  Google Scholar 

  9. Gainor BJ, Jeffries JT. Pronator syndrome associated with a persistent median artery. A case report. J Bone Joint Surg Am. 1987;69:303–4.

    CAS  PubMed  Google Scholar 

  10. Gassner EM, Schocke M, Peer S, Schwabegger A, Jaschke W, Bodner G. Persistent median artery in the carpal tunnel: color Doppler ultrasonographic findings. J Ultrasound Med. 2002;21:455–61.

    PubMed  Google Scholar 

  11. Gozdziewski S. Variation of the axial arteries of the upper extremity in man. Folia morphol (Warszawa). 1978;37:91–7.

    CAS  Google Scholar 

  12. Gutowski KA, Olivier WA, Mehrara BJ. Arteriovenous malformation of a persistent median artery with a bifurcated nerve. Plast Reconstr Surg. 2000;106:1336–9. doi:10.1097/00006534-200011000-00016.

    Article  CAS  PubMed  Google Scholar 

  13. Henneberg M, George BJ. High incidence of the median artery of the forearm in a sample of recent southern African cadavers. J Anat. 1992;180(Pt 1):185–8.

    PubMed  Google Scholar 

  14. 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;13:501–9.

    CAS  PubMed  Google Scholar 

  15. Jaschtschinski SN. Morphologie und Topography des Arcus volaris sublimis und profundus des Menschen. Anat Hefte. 1897;7:161–88.

    Google Scholar 

  16. Jones NF, Ming NL. Persistent median artery as a cause of pronator syndrome. J Hand Surg Am. 1988;13:728–32.

    Article  CAS  PubMed  Google Scholar 

  17. Karlsson S, Niechajev IA. Arterial anatomy of the upper extremity. Acta Radiol. 1982;23:115–21.

    CAS  Google Scholar 

  18. Keen JA. Study of the arterial variations in the limbs, with special reference to simetry of vascular patterns. Am J Anat. 1961;108:245–61. doi:10.1002/aja.1001080303.

    Article  CAS  PubMed  Google Scholar 

  19. Krol A, Palczak A, Jedrzejewski KS. Split median nerve. A report of two cases. Folia Morphol (Warsz). 2005;64:341–4.

    CAS  Google Scholar 

  20. Lavey EB, Pearl RM. Patent median artery as a cause of carpal tunnel syndrome. Ann Plast Surg. 1981;7:236–8. doi:10.1097/00000637-198107030-00010.

    CAS  PubMed  Google Scholar 

  21. Libersa C, Francke JP, Mauppin JM, Bailleul JP, Gamblin P. The arterial supply to the palm of the hand (arteriae palmae manus). Anat Clin. 1982;4:33–45. doi:10.1007/BF01811187.

    Article  Google Scholar 

  22. Loukas M, Holdman D, Holdman S. Anatomical variations of the superficial and deep palmar arches. Folia Morphol (Warsz). 2005;64:78–83.

    Google Scholar 

  23. Michelsen H, Posner MA. Medical history of carpal tunnel syndrome. Hand Clin. 2002;18:257–68. doi:10.1016/S0749-0712(01)00006-3.

    Article  PubMed  Google Scholar 

  24. Moraes SRA, Araújo TN, Silva AR, Paula AR, Salgado JL. Morphologic variations of the superficial palmar arc. Acta Cir Bras. 2003;18:183–8. doi:10.1590/S0102-86502003000300004.

    Article  Google Scholar 

  25. Olave E, Prates JC, Mandiola E, Del Sol Calderón M, Gabrielli C. Formaciones arteriales superficiales de la palma de la mano. Rev Chil Anat. 1993;11:35–40.

    Google Scholar 

  26. 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;31:13–6. doi:10.3109/02844319709010500.

    Article  CAS  Google Scholar 

  27. Pabst R, Lippert H. Beiderseitiges Vorkommen von A. brachialis superficialis, A. ulnaris superficialis und A. mediana. Anat Anz. 1968;123:223–6.

    CAS  PubMed  Google Scholar 

  28. Proudman TW, Menz PW. An anomaly of the median artery associated with the anterior interosseous nerve syndrome. J Hand Surg Br. 1992;17:507–9. doi:10.1016/S0266-7681(05)80231-1.

    CAS  PubMed  Google Scholar 

  29. Rodriguez-Baeza A, Nebot J, Ferreira B, Reina F, Perez J, Sanudo JR. An anatomical study and ontogenic explanation of 23 cases with variations in the main pattern of the human brachio-antebrachial arteries. J Anat. 1995;187:473–9.

    PubMed  Google Scholar 

  30. Rodríguez-Niedenführ M, Sanudo JR, Vázquez T, Nearn L, Logan B, Parkin I. Median artery revisited. J Anat. 1999;195:57–63. doi:10.1017/S0021878299005075.

    Article  PubMed  Google Scholar 

  31. Schwyzer AG, De Garis CF. Three diverse patterns of the arteria brachialis superficialis in man. Anat Rec. 1935;63:405–16. doi:10.1002/ar.1090630408.

    Article  Google Scholar 

  32. Srivastava SK, Pande BS. Anomalous pattern of median artery in the forearm of Indians. Acta Anat (Basel). 1990;138:193–4. doi:10.1159/000146938.

    Article  CAS  Google Scholar 

  33. Tagil SM, Cicekcibasi AE, Ogun TC, Buyukmumcu M, Salbacak A. Variations and clinical importance of the superficial palmar arch. S D U Typ Fak Derg. 2007;14:11–6.

    Google Scholar 

  34. Tandler J. Zur Anatomie der Arterien der Hand. Anatomische Hefte. 1897;7:263–81. doi:10.1007/BF02298035.

    Article  Google Scholar 

  35. Thoma A, Young JEM. The superficial ulnar artery ‘trap’ and the free forearm flap. Ann Plast Surg. 1992;28:370–2. doi:10.1097/00000637-199204000-00013.

    Article  CAS  PubMed  Google Scholar 

  36. Toranto IR. Aneurysm of the median artery causing recurrent carpal tunnel syndrome and anatomic review. Plast Reconstr Surg. 1989;84:510–2. doi:10.1097/00006534-198909000-00022.

    Article  CAS  PubMed  Google Scholar 

  37. Varley I, Wales CJ, Carter LM. The median artery: its potential implications for the radial forearm flap. J Plast Reconstr Aesthet Surg. 2008;61:693–5. doi:10.1016/j.bjps.2006.11.025.

    Article  PubMed  Google Scholar 

  38. von Lanz T, Wachsmuth W. Praktische Anatomie. Arm. Berlin: Springer. Erster Band, dritter Teil; 1959. pp 189, 200, 216.

  39. Williams PL. Gray’s anatomy, vol. 38. New York: Churchill Livingstone; 1995. p. 319. 1542.

    Google Scholar 

  40. Wood SJ, Abrahams PH, Sanudo JR, Ferreira BJ. Bilateral superficial radial artery at the wrist associated with a radial origin of a unilateral median artery. J Anat. 1997;189:691–3.

    Google Scholar 

  41. Wright C, MacFarlane I. Aneurysm of the median artery causing carpal tunnel syndrome. Aust N Z J Surg. 1994;64:66–7. doi:10.1111/j.1445-2197.1994.tb02142.x.

    Article  CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Anatomy, Centre for Basic Sciences, Bejai, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India, 575004

    Soubhagya R. Nayak, Ashwin Krishnamurthy, Latha V. Prabhu & Sujatha D’Costa

  2. Department of Anatomy, P.S.G Institute of Medical Sciences and Research, Peelamedu, Coimbatore, TamilNadu, India

    SJ Madhan Kumar

  3. Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

    Bhagath Kumar Potu

  4. Department of Anatomy, Gulf Medical University, P. O. Box 4184, Ajman, United Arab Emirates

    Anu Vinod Ranade

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  1. Soubhagya R. Nayak
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  2. Ashwin Krishnamurthy
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  4. Latha V. Prabhu
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Correspondence to Soubhagya R. Nayak.

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Nayak, S.R., Krishnamurthy, A., Kumar, S. et al. Palmar Type of Median Artery as a Source of Superficial Palmar Arch: A Cadaveric Study with Its Clinical Significance. HAND 5, 31–36 (2010). https://doi.org/10.1007/s11552-009-9197-4

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