Variation in formation of superficial palmar arches with clinical implications.

BACKGROUND: Knowledge of the variations in the arterial supply of hand has reached a point of practical importance with the advent of microvascular surgery for revascularization, replantation and composite tissue transfers. Arterial supply of hand is derived from two anastomotic arches, formed between two main arteries of forearm i.e. radial, ulnar and their branches, in the palm. OBJECTIVE: The superficial palmar arch shows variation in formation at the radial side. In the present study we have recorded its data which would help in its clinical and surgical implications. MATERIAL AND METHODS: In the present study we have studied the formation of superficial palmar arches and their variations in 100 cadaveric hands at Dr. D . Y. Patil Medical College, Pune and B.J. Government Medical College, Pune, India. RESULT AND CONCLUSION: According to Adachi's classification the most predominant pattern obseved was of Ulnar type arch (66%). According to Coleman and Anson classification 82% showed complete (Group I) superficial palmar arches and a very low incidence (18%) of incomplete arches (Group II). This suggests that collateral circulation is present in majority of cases. This would result in least number of complications considering radial artery harvesting for coronary bypass. Sub-classification of arches according to Coleman and Anson 1961 indicates that the predominant type in the present study was of Group I (Type B) which is formed entirely by Ulnar Artery (56%). Median artery and ulnar artery forming an incomplete superficial arch under Group II (Type C) having an incidence of 4% was recorded. Thus in such cases radial artery harvesting for coronary artery bypass may prove to be less fatal. This study is an effort to provide data about the formation of superficial palmar arches which has been a centre of attraction for most of the surgical procedures and injuries of the hand.

Variations in the vascular supply of the upper one third of the sciatic nerve

The arteria comitans nervi ischiadica (ACNI), which is a branch of the inferior gluteal artery and represents the axial artery of the inferior extremity, supplies the sciatic nerve in gluteal region. The vascular supply of the upper 1/3rd of the sciatic nerve and the morphological details of the ACNI have not been characterized yet in detail. Hence, we studied the extraneuronal blood supply of the upper 1/3rd of the sciatic nerve by cadaveric dissection. The upper 1/3rd of the sciatic nerve was dissected in the gluteal region by reflecting the gluteus maximus muscle in 33 formalin-fixed cadavers. Variations in the number of ACNI arising from the inferior gluteal artery and length of segments of ACNI were noted. The source of other nutrient branches supplying the sciatic nerve in the gluteal region was also noted. In 86.6% of cases one ACNI was found. 9% of limbs had two ACNI and 1.8% had three ACNI arising respectively from the inferior gluteal artery (IGA). The morphology of the ACNI was studied in three segments and it showed variation in length. Blood supply to the sciatic nerve was assisted by the nutrient branches from trochanteric & cruciate anastomosis in 71% of cases, and branches from the artery accompanying the posterior cutaneous nerve of the thigh in 34% of cases. Both sources assisted blood supply in 3% of cases. Detailed knowledge of blood supply to the peripheral nerve is essential for surgeons dealing with peripheral nerve injuries

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Morphometric Study of the Atlas Vertebra using Manual Method.

ABSTRACT: The atlas (first cervical vertebra) has undergone many structural modifications. It is critically located and close to the 'life centres'. For this study, one hundred dried intact human atlas vertebrae from the Indian population were measured using a digital Vernier calliper that provides accurate resolution up to 0.01 mm. The distance between the tips of the transverse process, the outer and the inner distance between the foramen transversaria and various diameters of vertebral foramen were measured. The mean width of the measured atlases was 69.37 mm. The mean distance between the lateral margins of foramen transversaria was 55.66 mm and the inner distance was 45.93 mm. The mean thickness of vertebral artery grooves was 3.72 ± 1.06 mm. The observations made in the present study may help in improving understanding of various bony dimensions while operating close to important structures like nerve roots and the vertebral artery. KEY WORDS: Atlas, Atypical cervical vertebra, C1, morphology.

Morphometric Study of the Atlas Vertebra using Manual Method

The atlas (first cervical vertebra) has undergone many structural modifications. It is critically located and close to the ‘life centres’. For this study, one hundred dried intact human atlas vertebrae from the Indian population were measured using a digital Vernier calliper that provides accurate resolution up to 0.01 mm. The distance between the tips of the transverse process, the outer and the inner distance between the foramen transversaria and various diameters of vertebral foramen were measured. The mean width of the measured atlases was 69.37 mm. The mean distance between the lateral margins of foramen transversaria was 55.66 mm and the inner distance was 45.93 mm. The mean thickness of vertebral artery grooves was 3.72 + 1.06 mm. The observations made in the present study may help in improving understanding of various bony dimensions while operating close to important structures like nerve roots and the vertebral artery.