The Surgical Anatomy of the Superficial and Deep Palmar Arches: a Meta-Analysis

Publication date: Available online 24 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Michał P. Zarzecki, Patrick Popieluszko, Alexander Zayachkowski, Przemysław A. Pękala, Brandon M. Henry, Krzysztof A. Tomaszewski

ABSTRACT

Introduction

The following study aimed to find the pooled prevalence estimate of anatomical variations in the palmar vasculature, namely the superficial palmar arch (SPA) and the deep palmar arch (DPA). The importance of understanding the vasculature of the hand is critical with the increasing use of hand microsurgery.

Methods

Major online medical databases (Pubmed, EMBASE, ScienceDirect, and Web of Science) were extensively searched for terms pertaining to the SPA, the DPA, their anatomy and variations. Articles reporting data on the SPA and/or the DPA were collected and their data extracted. Furthermore, a reference search was performed, allowing to pinpoint any articles that were not previously found. The collected data was analysed using MetaXL 5.3.

Results

The analysis included thirty-six studies (n=4841 palmar arches). The SPA was found to be complete in 81.3%, with the radio-ulnar anastomosis being the most common variant (72.0%). The incomplete SPA was present in 18.7%, with the ulnar artery supplying the third finger from both radial and ulnar side as the most prevalent in 34.8%. The DPA was found to be complete in 95.2%.

Conclusion

In this study, the SPA was predominantly complete, with the anastomosis between the radial and the ulnar artery being prevalent most often. Furthermore, the DPA was also complete in the vast majority of cases. The palmar arches and their variations should be kept in mind when considering the use of palmar vasculature for cardiac catheterization and other medical procedures, due to the risk of iatrogenic ischaemic hand complications.