ARTERIAL ARCHES OF PALM

SUPERFICIAL PALMAR ARCH

Also called-• SUPERFICIAL VOLAR ARCH• SUPERFICIAL ULNAR ARCH• ARCUS PALMARIS SUPERFICIALIS• ARCUS VOLARIS SUPERFICILAIS

It is an arterialarcade (arch) and the dominant vascular structure of the palm.

It is defined as the anastomoses between the superficial branch of the ulnar artery and superficial palmar branch of the radial Artery(usually).

There are some variations seen in this too i.e. The arch is variable.

SITUATION:

• The convexity of the arch is directed towards the fingers. • The distal point of the arch lies at the same level as the distal border of thenar eminence when the thumb is fully extended.

FORMATION: Medially: Normally,it begins as a terminal branch of the ulnar artery on the flexor retinaculum distal to the pisiform bone. The arch: It then crosses the hook of the hamate bone and turns laterally deep to the palmar aponeurosis. Laterally: It passes between abductor and flexor digiti minimi. It joins the superficial palmar branch of the radial artery.

RELATIONS: Superficially: Palmar Aponeurosis Palmaris brevis

Deeply: Flexor digiti minimi Flexor tendons of fingers The lumbricals The digital branches of median nerve.

BRANCHES: The branches arise from the convexity of the arch. The main branches are the 4 palmar digital arteries.

The most medial is the PROPER PALMAR DIGITAL BRANCH, supplying the medial side of the little finger. The other three called the COMMON PALMAR DIGITAL BRANCHES, pass to the interdigital clefts. There, each receives the corresponding palmar metacarpal artery from the deep palmar arch. Then they divide into 2 PROPER PALMAR DIGITAL BRANCHES to the adjacent sides of two fingers.

Thus, these branches supply the adjacent sides of little and ring, ring and middle, middle and index fingers. THE PALAMR DIGITAL ARTERIES SUPPLY THE MEDIAL 3&½ FINGERS.

VARIATIONS:

The superficial palmar arch is formed predominantly by the ulnar artery, with a contribution from the superficial palmar branch of the radial artery. However, in some individuals the contribution from the radial artery might be absent, and instead anastomoses with either the princeps pollicis artery, the radialis indicis artery, or the median artery, the former two of which are branches from the radial artery.

ARTERIAL PATTERN IN THE PULP OF FINGERS:

The two digital branches running along the sides of the fingers ends in a rich arterial anastomoses at the pulp space on the fingers.

DEEP PALMAR ARCH The deep palmar arch (or deep volar arch) is an arterial network found in the palm, deep to the superficial palmar arch. It provides a second channel connecting the ulnar and radial arteries.

FORMATION: The deep palmar arch is formed mainly by the terminal part of the radial artery, and is completed maedially at the base of the fifth metacarpal bone by the deep palmar branch of the ulnar artery.

RELATIONS: Superficially:• the oblique head of the adductor pollisis muscle, • the flexor tendons of the fingers, • the lumbricals of the hand.

deeply:• the bases of the metacarpal bones,• the interossei of the hand.

BRANCHES: From its convexity i.e. from its distal side, the arch gives of three palmar metacarpal arteries, which distally in the 2nd, 3rd and 4th spaces, supply the medial 4 metacarpals, and terminate at the finger clefts by joining the common digital branches of the superficial palmar arch.

Dorsally, the arch gives off three (proximal) perforating arteries which pass through the medial three interosseous spaces to anastomose with the dorsal metacarpal arteries. The digital perforating arteries connect the palmar digital branches of the superficial palmar arch with the dorsal metacarpal arteries.

Recurrent branch arises from the concavity of the arch and pass proximally to supply the carpal bones and joints, and ends in the palmar carpal arch.

APPLIED ASPECTS:

The presence of variations in the superficial palmar arch is of surgical importance and whenever a surgery in done in the palmar aspect of hand,these variations if present, must be identified and approached accordingly.