Cadaveric study of superficial palmar arch variations in northern Thai population by using epoxy resin injection technique.

BACKGROUND: Superficial palmer arch (SPA) is the main source of arterial supply to the palm whileprincepspollicis artery is the main source of arterial supply to the thumb. The details about their possible variations are important for the reconstructive hand surgeons. OBJECTIVE: To find out the SPA patterns and arterial supply of thumb variations in Thai population by using epoxy resin injection technique. MATERIAL AND METHOD: The methods used were vascular injection by epoxy resin with blue resin color to brachial artery before dissection of 100 fresh cadaveric hands to find out the SPA pattern and the anatomical variation of the princeps pollicis artery. RESULTS: It was found that the SPA patterns of 100 cadaveric hands were composed of 13 patterns, which could be classified into two main types: arch type and non-arch type. Arch type was found in 67 hands (67%) and non-arch type 33 hands (33%). From 13 patterns, the most common was the ulnar + 1st dorsal interosseous pattern, which found in 27 hands (27%) and the less common, in 15 hands was ulnar pattern in both arch type and non-arch type. The princeps pollicis artery was present in all of the arch-type hands (67 hands) with its origin from the radial artery. It emerged deep in the 1st dorsal interosseous muscle in 66 hands (98.5%) and dorsally to this muscle in 1 hand (1.5%). Using epoxy resin injection before dissection was a good technique with less confusion for arteries and other tissues. CONCLUSION: The authors found 13 superficial palmar arch patterns, 67 percent is arch type. The princeps pollicis artery always lies deep in the first dorsal interosseous muscle. This is essential knowledge for the hand surgeon to repair or reconstruct the injured limb.

Perforator arteries of the medial upper arm: anatomical basis of a new flap donor site.

The development of perforator flaps' concept based on knowledge on vascular anatomy of the skin represents a major improvement in reconstructive surgery. Succeeding description about vascular territories and anatomical basics of the main donor sites, the study of hidden donor sites, such as medial upper arm, constitutes a new step and an additional refinement. 20 upper limbs of 10 fresh adult cadavers were studied with colored latex injections. The origin and distribution of the perforator arteries of the superior ulnar collateral artery and the brachial artery were investigated. We have noted constant perforator arteries and described the limits of vascular territories of the medial upper arm.

Anatomical basis of a proximal fasciocutaneous extension of the distal-based posterior interosseous flap that allows exclusion of the proximal posterior interosseous artery.

OBJECTIVE: The objective of this study was to provide anatomical information for the repair of small tissue defects in the hand with posterior interosseous artery chain-link perforator flaps, a proximal fasciocutaneous extension of the distal-based posterior interosseous flap, which allows the exclusion of the proximal posterior interosseous artery. METHODS: Fourteen posterior interosseous artery chain-link perforator flaps taken from human cadavers were studied by the following three methods: latex perfusion for microanatomy analysis, denture material and vinyl chloride mixed packing for cast analysis, and latex perfusion for the production of clearance specimens. Statistical analysis was performed on cutaneous perforators coming from the intermuscular septum of the extensor carpi ulnaris and the extensor digitorum communis. A cluster analysis was conducted to determine the overall distribution of perforators. RESULTS: There are two main clusters of perforators at a relative distance of 21% and 48% along the ulnar head-to-lateral epicondyle interval. On average, the posterior interosseous artery extends six cutaneous perforators through the intermuscular septum of the extensor carpi ulnaris and the extensor digitorum communis. Of these six arteries, two are clinically significant perforators (0.5 mm or more in diameter) and are located 6 ± 2 cm proximal to the head of the ulna and 10 ± 1 cm distal to the lateral epicondyle of the humerus. Their mean diameters are 0.5 ± 0.1 and 0.6 ± 0.1 mm, with pedicle lengths of 16.8 ± 5.1 and 21.2 ± 12.3 mm, respectively. At the two main clusters of perforator-intensive sites, the vessel chains formed by adjacent perforators are parallel to the intermuscular septum of the extensor carpi ulnaris and the extensor digitorum communis. CONCLUSIONS: This study demonstrates that the posterior interosseous artery has two main clusters of perforators in the middle and distal one-fifth of the forearm, which can be used for repairing hand defects with posterior interosseous artery chain-link perforator flaps.

The extraosseous and intraosseous arterial anatomy of the adult elbow.

UNLABELLED: We investigated the extraosseous and intraosseous arterial anatomy of the human adult elbow. Twenty-two fresh adult cadaveric upper extremities were studied with a technique of combined India-ink and latex injection followed by chemical débridement. The intraosseous vascularity of twelve extremities was then evaluated with a rapid Spalteholz clearing technique. Our findings demonstrated consistent patterns of extraosseous and intraosseous vascular anatomy, which were organized into three vascular arcades: medial, lateral, and posterior. The medial arcade was formed by the superior and inferior ulnar collateral arteries and the posterior ulnar recurrent artery. The lateral arcade was formed by the radial and middle collateral, radial recurrent, and interosseous recurrent arteries. The posterior arcade was formed by the medial and lateral arcades and the middle collateral artery. The intraosseous circulation of the elbow, which was segmental in organization, appeared to be dependent on the local blood supply. The capitellum and the lateral aspect of the trochlea were supplied by posterior perforating vessels arising from the radial recurrent, radial collateral, and interosseous recurrent arteries. The medial aspect of the trochlea was supplied by a circumferential vascular ring originating from the inferior ulnar collateral artery. Watershed areas were apparent between the blood supplies to the medial and lateral aspects of the distal end of the humerus. The olecranon was richly supplied by vessels coursing along its medial aspect from the posterior ulnar recurrent artery and along its lateral aspect from the interosseous recurrent artery. The radial head had a dual extraosseous blood supply from a single branch of the radial recurrent artery, which supplied the head directly, and from additional vessels from both the radial and the interosseous recurrent artery, which penetrated the capsular insertion at the neck of the radius. CLINICAL RELEVANCE: Our findings demonstrate that arterial contributions to the intraosseous circulation of the elbow are more specific than previously appreciated. The intraosseous circulation of the elbow is derived mainly from perforating vessels that arise from neighboring extraosseous arteries. These perforating arteries may be damaged by trauma or by extensile dissection during reconstruction of the elbow. An understanding of the extraosseous and intraosseous circulation of the elbow may help to avoid iatrogenic injury to the intraosseous circulation.

An anatomical study on the characteristics of cutaneous branches-chain perforator flap with ulnar artery pedicle.

BACKGROUND: The objective of this study was to provide anatomical information for the repair of small tissue defects in the hands and forearms with ulnar artery pedicle cutaneous branches-chain perforator flaps. METHODS: Twelve ulnar artery pedicle cutaneous branches-chain perforator flaps taken from human cadavers were studied using three methods: latex perfusion for microanatomy analysis, denture material and vinyl chloride mixed packing for cast analysis, and polyvinyl alcohol and bismuth oxide perfusion for molybdenum target x-ray arteriography. Statistical analysis was performed on cutaneous perforators with a diameter of 0.2 mm or greater. Cluster analysis was conducted to determine the overall distribution of perforators. RESULTS: There are two main clusters of perforators at a relative distance of 22.34 percent and 58.73 percent along the pisiform bone to the medial epicondyle. Two thick cutaneous perforators extend through the flexor digitorum superficialis and the flexor carpi ulnaris muscle gap, which are located 4.57 ± 0.59 cm proximal to the pisiform bone and 7.73 ± 1.14 cm distal to the medial epicondyle, with diameters of 0.63 ± 0.09 and 0.75 ± 0.15 mm and pedicle lengths of 1.49 ± 0.34 and 1.46 ± 0.54 cm. At the two main clusters of perforator-intensive sites, vessel chains formed by adjacent perforators were parallel to the flexor digitorum superficialis and the flexor carpi ulnaris muscle gap. CONCLUSION: This study demonstrated that the ulnar artery has two main clusters of perforators in the proximal one-third and distal one-fourth of the forearm, which can be used for ulnar artery pedicle cutaneous branches-chain perforator flaps to repair hand and forearm parenchymal defects.

The extraneural and intraneural arterial anatomy of the ulnar nerve at the elbow.

The purpose of this report was to investigate the vascular anatomy of the ulnar nerve at the elbow with a technique of combined India ink and latex injection followed by nondissection chemical debridement. Twenty-two fresh human cadaveric arms were injected with India ink to stain the intraneural microcirculation followed immediately by latex injection and chemical debridement for study of the extraneural vascularization. After clearing with a modified Spalteholtz technique, the intraneural blood supply was studied in 10 of the specimens. The findings demonstrated a consistent but segmental extraneural and intraneural vascular supply from the superior ulnar collateral, inferior ulnar collateral, and posterior ulnar recurrent arteries. No identifiable direct anastomosis was seen between the superior ulnar collateral and posterior ulnar recurrent arteries in 20 of 22 arms. The inferior ulnar collateral artery provided the only direct vascularization to the nerve in the region just proximal to the cubital tunnel. Although the clinical importance of maintaining specific arterial sources to the ulnar nerve has not been determined, these anatomic findings indicate that the arterial contribution from the inferior ulnar collateral artery may be more important than appreciated previously.

Anatomical basis for a fasciocutaneous flap from the hypothenar eminence of the hand.

Thirty-two fresh cadaver hands were perfused with a silicone rubber compound (Microfil) and dissected to explore the vascular and neural anatomy of the hypothenar eminence, in order to assess the possibility for free or pedicled island flaps from this area. In five specimens Microfil was selectively injected into the ulnar palmar digital artery of the little finger to determine the skin territory nourished by this artery. The hypothenar eminence was divided into three territories according to the type of nutrient artery supplying each territory. Among the three territories, the distal half of the ulnar aspect of the hypothenar eminence (approximately 3 x 2 cm), located over the abductor and flexor digiti minimi muscles, had a constant vascular and neural supply from the ulnar palmar digital artery of the little finger and the dorsal or palmar cutaneous branch of the ulnar nerve. This fasciocutaneous area provides a new and feasible donor site for free or pedicled island skin flaps to repair palmar skin defects of the fingers.

[The vascularization of the common synovial sheath and the tendons of the flexor muscles of the carpal tunnel]. / La vascularisation de la gaine synoviale commune et des tendons des muscles fléchisseurs dans le canal carpien.

The detailed anatomy of the tendon apparatus, the blood supply of the superficial (FDS) and profundus (FDP) flexor muscles and the blood supply of the common synovial sheath in the carpal tunnel were studied on 200 hundred upper extremities from fresh human cadavers. The injection of coloured latex or the aqueous solution of India ink and gelatin revealed a complex arterial network. Dissection of the carpal tunnel revealed the existence of different sources of the blood supply of the tendons of the flexor muscles and carpal sheath. The different sources and zones of vascularization are described. This study concerns the synovial and tendinous apparatus of the flexor muscles as well as their blood supply in the carpal tunnel. These data may be of interest hand surgeons.

Organización de las arterias digitales palmares en individuos brasileños / Organization of the palmar digital arteries in brazilian individuals

La irrigación de la palma está dad fundamentalmente por las arterias ulnar y radial, las que pudene anastomosarse a través de ramas de las mismas, para formar los conocidos arcos palmares superficial y profundo. Del primero de ellos se originan las arterias digitales palmares comunes (DPC) y algunas arterias digitales palmares propias (DPP). Agrupamos y clasificamos a estas arterias, tanto en presencia del arco palmar superficial (APS) como en ausencia del mismo. Para ello, utilizamos 90 regiones palmares de 45 cadáveres formolizados de individuos brasileños, adultos, de ambos sexos, pertenecientes a la disciplina de anatomía descriptiva e topográfica de la Universidade Federal de Sao Paulo, Brasil. Del total de muestras, 30 de ellas fueron inyectadas con látex neopreno (Artifix L-14). El APS fue observado en 70 por ciento de los casos. En éstos consideramos 7 tipos de origen y disposición de las aa. digitales palmares. El tipo A con 4aa. DPC (1º,2º,3º y 4ºespacio) más la arteria DPP ulnar del dedo mínimo y la arteria DPP radial del indicador derivada de la arteria DPC del 1º espacio, fue observado en 42,2 por ciento. El tipo B (8,9 por ciento) difiere del tipo A, solamente en que la arteria DPP radial del indicador provino de la formación arterial profunda. La ausencia del APS se observó en 30 por ciento. En estos casos las arterias digitales palmares se clasificaron en 6 tipos. El padrón A fue el más frecuente (12,2 por ciento), donde las arterias DPC del 2º,3º y 4º espacio y la arteria del dedo mínimo procedieron de la arteria ulnar y la del 1º espacio que participa en la irrigación del pulgar y d la parte radial del indicador, fue otorgada por la rama palmar superficial de la arteria radial, arteria principal del pulgar o arteria mediana. El padrón que siguió en frecuencia fue el C, con un 6,7 por ciento y en éste la arteria ulnar emitió la arteria DPP ulnar del dedo mínimo más las arterias DPC para los espacios 3º y 4º, las del 1º y 2º espacio provinieron de la arteria mediana, anastomosada o no, con una rama de la arteria radial