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In this article we describe a unique and complex variation in the arterial pattern of the left hand of a female cadaver. The following variations were found in this case: a) persistent median artery of the palmar type, terminating in the hand as the princeps pollicis and radialis indicis arteries; b) the ulnar artery giving only two common palmar digital arteries; c) the second digital palmar artery without division into two digital branches and instead supplying only the radial side of the ring finger; d) absence of the first common digital artery with the contiguous sides of the second web space supplied by the first palmar metacarpal artery from the deep palmar arch; e) early bifurcation of the median nerve proximal to the flexor retinaculum.
The use of radial arteries as an arterial bypass conduit is an invasive procedure which is becoming popular among various medical centres. The greatest risk associated with harvesting the radial artery is ischaemia of the soft tissues of the hand. In this study we dissected 200 hands derived from 100 formalin-fixed cadavers in order to identify arterial patterns that will allow safe removal of the radial artery for use in bypass procedures. A complete superficial palmar arch (SPA) was found in 90% of the cases and divided into 5 types, while the remaining 10% possessed an incomplete palmar arch. Types of SPA are designated by the letter S. In type S-I (40%), the SPA is formed by anastomosis of the superficial volar branch of the radial artery to the ulnar artery. Type S-II (35%) is formed entirely of the ulnar artery. Type S-III (15%) is formed by anastomosis of the ulnar and median arteries. Type S-IV (6%) is formed by anastomosis of the ulnar, radial, and median arteries and Type S-V (4%) is formed by a branch of the deep palmar arch (DPA) communicating with the SPA.DPA was identified in all specimens and classified into three types, all designated by the letter D. Type D-I (60%) is formed by anastomosis of the deep volar branch of the radial artery and the inferior deep branch of the ulnar branch. Type D-II (30%) is formed by anastomosis of the deep volar branch of the radial artery and the superior deep branch of the ulnar artery. Type D-III (10%) is formed by anastomosis of the deep volar branch of the radial artery with both deep branches of the ulnar artery. This data could provide an important source of information for vascular surgeons harvesting radial arteries.
The median artery usually regresses after the eighth week of intrauterine life, but in some cases it persists into adulthood. The persistent median artery (PMA) passes through the carpal tunnel of the wrist, accompanying the median nerve. During anatomical dissection in our department, we found two unilateral cases of PMA originating from the ulnar artery. In both cases the PMA passed through the carpal tunnel, reached the palm, and anastomosed with the ulnar artery, forming a medio-ulnar type of superficial palmar arch. In addition, in both cases we observed a high division of the median nerve before entering the carpal tunnel. Such an artery may result in several complications such as carpal tunnel syndrome, pronator syndrome, or compression of the anterior interosseous nerve. Therefore, the presence of a PMA should be taken into consideration in clinical practice. This study presents two cases of PMA along with an embryological explanation, analysis of its clinical significance, and a review of the literature. The review of the literature includes cases observed during surgical procedures or anatomical dissections. Cases observed by means of imaging techniques were not included in the study. (Folia Morphol 2009; 68, 4: 193–200)
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