An unusual topographic relationship between high origin of superficial ulnar artery and bitendinous palmaris longus.

The ulnar artery usually arises from the brachial artery at the cubital fossa. It descends beneath the flexor carpi ulnaris in the forearm and then terminates at the wrist joint by forming the superficial palmar arch with the contributory radial artery. In the present study, we report a more proximal origin of ulnar artery presenting a superficial course in the lower portion of the upper extremity, termed superficial ulnar artery. Interestingly, this artery lies superficially to a bitendinous palmaris longus, a variant muscle in the forearm. The relation between arterial and muscular variations may be useful during clinical procedures such as angiography, forearm flap and tendon grafting as well as avoiding accidental intra-arterial injection.

Vascular Reconstruction of a Brachial Artery Aneurysm Proximally to an Arteriovenous Malformation.

Brachial artery aneurysms and arteriovenous malformations (AVM) are limb-threatening vascular anomalies. This patient presented with a bilobed brachial artery aneurysm in the antecubital fossa proximally to an AVM arising from the dorsal interosseous and ulnar arteries that had been treated with endovascular embolization, leaving the hand solely supplied by the radial artery. The aneurysm continued to increase in size and imaging revealed concomitant thrombus. A femoral vein interposition graft was used to repair the aneurysm, and postoperatively, the patient retained full left arm function.

The Advantages of Using Intraoperative Indocyanine Green Fluorescence Angiography for Upper Extremity Arteriovenous Malformation: A Case Report.

Vascular anomaly is a general term that includes all vascular malformations, vascular tumors, and other congenital vascular defects. Vascular malformation is the most common term, and it describes blood vessels that are abnormally formed at birth. Vascular malformations can develop in any part of the body. The most common location is in the lower extremities. Vascular malformations involve arteries, veins, or lymphatic vessels, or a combination of these. Our patient was a 22-year-old man with an arteriovenous malformation in his left forearm. He was admitted due to increased pain and swelling on his left forearm over the previous 9 months. He had 1 arterial feeder derived from the ulnar artery and 2 venous drainage systems at the magnetic resonance angiography. We used indocyanine green fluorescence angiography to assess the arteriovenous malformation during surgery. We found that it was a very useful and unique technique for assessing the anomalies of the vascular anatomy and eradicating the nidus of the arteriovenous malformation. It could prove to be very helpful in avoiding significant blood loss during surgery.

Accessory flexor carpi ulnaris muscle with associated anterior interosseous artery variation: case report with the definition of a new type and review of concomitant variants.

PURPOSE: Knowledge of accessory flexor carpi ulnaris (AFCU) is not only important for proper orientation in the surgical field but it can be used for tendon transfer as well. AFCU commonly occurs with concomitant variants, and its presence should rise caution in order to prevent iatrogenic injury. METHODS: During a routine dissection for research data collection at the Institute of Anatomy, a AFCU with concomitant variants was observed in a European cadaver fixed with Thiel's method. A thorough review of the literature concerning all the encountered variants was performed. RESULTS: AFCU was found in the right upper limb with its insertion on the flexor retinaculum. Palmaris longus muscle was absent in this limb, and an accessory branch of the anterior interosseous artery coursed over the pronator quadratus muscle to anastomose with the ulnar artery 5 cm proximally to the pisiform. On the left hand, a variable lumbrical of the second finger originating from the flexor retinaculum was found, which was not described in the literature before. CONCLUSIONS: AFCU commonly occurs together with concomitant variants, and special attention is needed when performing surgery on such forearm.

Arteria ulnar superficial, bilateral y antebraquial: similitudes y diferencias / Superficial ulnar artery, bilateral and antebrachial: similarities and differences

Describimos un hallazgo infrecuente de arteria ulnar superficial en ambos antebrazos de un cadáver, con origen en la arteria braquial, a nivel de la fosa cubital. Las arterias presentan un trayecto que dividimos en cuatro segmentos, a causa de sus flexuosidades. Ambos antebrazos presentan ausencia del músculo palmaris longus. Se resumen las principales teorías sobre su desarrollo y las complicaciones que pueden ser ocasionadas por su presencia y el eventual beneficio de la misma. Hasta el momento, no hemos encontrado en la literatura, una disposición morfológica de arterias ulnares superficiales como las aquí descritas.

We describe an infrequent finding of a superficial ulnar artery in both cadaver forearms, which originates in the brachial artery at cubital fossa level. The arteries have a path that we divided into four segments, because of their flexuosities. Both forearms showed an absence of the palmaris longus muscle. This summarizes the main theories about its development and the complications and eventual benefits that can be caused by its presence. So far, we have not found in the literature, a morphological disposition of superficial ulnar arteries such as those described here.

Superficial Ulnar Artery Crossing Over the Palmaris Longus Tendon at the Wrist in a Cadaver: A Case Report.

Superficial ulnar artery (SUA) is defined as arterial variation of an ulnar artery of high origin that lies superficially in the forearm. Because an SUA may be mistaken for a superficial vein, there is a risk of arterial damage. During routine dissection of the cadaver, we incidentally detected a case of unilateral SUA in the left arm. SUA arose from the axillary artery and descended superficial to the axillary artery and median nerve. At the wrist, the SUA crossed over palmaris longus (PL) tendon from the radial side to the ulnar side. In this cadaver, the PL tendon was located on the ulnar side and was thicker than the flexor carpi radialis tendon. Clinicians should check for the presence of SUA before any technical procedure, because lack of awareness of its presence can have serious consequences.

Progressive fingertip necrosis after nail avulsion injury in a patient with ulnar artery hypoplasia: A case report.

RATIONALE: Slowly progressive hand ischemia is mostly associated with medical illness such as vasculitis, and in patients with smoking history, Buerger disease is often considered first. However, despite the very low incidence of vascular anatomical anomalies, they can lead to hand ischemia. And if there is no consideration for them, proper treatment cannot be selected. PATIENT CONCERNS: A 42-year-old male smoker presented with a slowly progressing 5th fingertip necrosis following blunt trauma. DIAGNOSES: Angiography revealed congenital hypoplasia of ulnar artery, and excluded Buerger disease or hypothenar hammer syndrome. INTERVENTIONS AND OUTCOMES: We reconstructed the necrotic fingertip using a 2nd toe pulp free flap to reflect the patient's need. LESSONS: In this case report, the authors emphasize that the possibility of anatomical anomaly should be considered as a cause of the ischemia. Vascular imaging should be undertaken to investigate the cause of ischemia of the hand.

Anomalies of radial and ulnar arteries / Anomalias nas artérias radial e ulnar

Abstract During dissection conducted in an anatomy department of the right upper limb of the cadaver of a 70-year-old male, both origin and course of the radial and ulnar arteries were found to be anomalous. After descending 5.5 cm from the lower border of the teres major, the brachial artery anomalously bifurcated into a radial artery medially and an ulnar artery laterally. In the arm, the ulnar artery lay lateral to the median nerve. It followed a normal course in the forearm. The radial artery was medial to the median nerve in the arm and then, at the level of the medial epicondyle, it crossed from the medial to the lateral side of the forearm, superficial to the flexor muscles. The course of the radial artery was superficial and tortuous throughout the arm and forearm. The variations of radial and ulnar arteries described above were associated with anomalous formation and course of the median nerve in the arm. Knowledge of neurovascular anomalies are important for vascular surgeons and radiologists.

Resumo Durante dissecção de membro superior direito de um cadáver de 70 anos, do sexo masculino, conduzida em um departamento de anatomia, foram observadas anomalias tanto na origem quanto no curso das artérias radial e ulnar. Após descer 5,5 cm desde a borda inferior do músculo redondo maior, a artéria braquial anomalamente se bifurcava em uma artéria radial medialmente, e em uma artéria ulnar lateralmente. No braço, a artéria ulnar se encontrava ao lado do nervo mediano, e seguia um curso normal no antebraço. A artéria radial se encontrava medialmente ao nervo mediano no braço e, então, no nível do epicôndilo medial, ela cruzava do lado medial para o lado lateral do antebraço, na superfície dos músculos flexores. O curso da artéria radial era superficial e tortuoso em todo o braço e antebraço. As variações das artérias radial e ulnar aqui descritas foram associadas a formação e curso anômalos do nervo mediano no braço. Conhecimento sobre anomalias neurovasculares são importantes para cirurgiões vasculares e radiologistas.

Persistent Median Artery Crossing and Continuing Distally as Ulnar Artery: Case Report.

The finding of a persistent median artery coursing superficial to the flexor tendons in the distal forearm is described.

[Superficial ulnar artery: Case report]. / À propos d'un cas d'artère ulnaire superficielle.

The anatomical variations of arterial axes of the upper limb are not uncommon and must be known to allow for safe surgical procedures and in order to limit the morbidity of these procedures. The superficial ulnar artery represents, after the variations in origin of the radial artery, the second most frequent variation in this area. When present, reconstructive procedures may be modified, especially when harvesting forearm free flaps, in order to choose this vessel as nourishing pedicle. The authors present the case of a superficial ulnar artery revealed intraoperatively while harvesting a radial forearm free flap, and a review of their cases in order to assess the frequency of this variation, and correlate it to literature.

Patient with a Hook of the Hamate Fracture Presenting as Vascular Occlusion: Diagnosis Made with Bedside Ultrasound.

BACKGROUND: Hook of the hamate fractures are particularly rare carpal fractures with significant morbidity if not diagnosed early. Classically, these fractures occur from localized blunt trauma to the hook of the hamate in racket sports. Common complaints include pain localized in the hypothenar eminence and reduced grip strength. Hook of the hamate fractures have the potential to cause significant injury to the ulnar nerve and artery. CASE REPORT: We present the case of a 43-year-old man with hypothenar pain, paresthesias of the fifth finger and ulnar aspect of the fourth finger, and pallor of the fourth and fifth fingers. Using bedside ultrasonography, the patient was found to have a fracture of the hook of the hamate that was causing compression of the ulnar artery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fracture of the hook of the hamate is often not seen on x-ray studies, and fracture fragments can cause compression of adjacent structures, including the ulnar and median nerves and ulnar artery. Bedside ultrasound may be a useful adjunct in the diagnosis of this carpal fracture when standard x-ray studies do not show a fracture and clinical presentation is concerning for the diagnosis.

Unusual Anatomic Variations Associated With Bilateral Ulnar Artery Hypoplasia.

Variations and anomalies of upper extremities have been commonly reported in routine dissection, clinical practices, and cadaver studies. Despite ongoing research on arterial variations of upper extremities, the absence of bilateral ulnar artery is extremely rare with only 3 patients reported. As the authors are presenting a successfully treated patient, initially prepped for radial forearm osteocutaneous free flap for treatment on oromandibular defect after a wide resection of head and neck cancer lesion, being confirmed to have bilateral ulnar artery hypoplasia and due to this, the patient had to change her surgical plan to fibular osteocutaneous free flap.

Palmar arch anatomy: Ajmer Working Group classification.

INTRODUCTION: Forearm arteries are frequently used as workhorse site for cardiac catheterization, bypass grafting and haemodialysis access. There is paucity of data on palmar circulation in live human being and only cadaveric data are available till date. We, therefore, made an attempt to look at the various patterns of sufficient or insufficient palmar arch circulation and various anomalies of forearm arteries, to discuss their clinical implications. METHODS AND RESULTS: We obtained the forearm and hand arteriograms of patients (n = 302) through radial (n = 200) and ulnar routes (n = 102). Modified Allen's test was normal in all of our patients. On the basis of predetermined parameters angiograms were analysed and findings were divided into three groups. These three groups were further classified as type A, type B, type C superficial palmar arch. CONCLUSION: We concluded that type A superficial palmar arch is most suitable for providing adequate collateral circulation in case of harvesting of forearm vessel, whereas type C superficial palmar arch appears to be highly susceptible for digital ischemia in case of radial or ulnar artery occlusion. Modified Allen's test alone is not justifiable for documenting good collateral circulation and it should be supplemented by other tests to document good collateral circulation before proceeding to any radical procedure.

A radial artery originating from the thoracoacromial artery.

PURPOSE: The purpose of this case report is to report a rare vascular variation in the upper limbs because of its clinical importance and embryological implication. METHODS: During the educational dissection of a 73-year-old Korean male cadaver`s right upper limb, we found a variant branch which is originated from the thoracoacromial artery. RESULTS: The variant branch from the thoracoacromial artery ran to the distal forearm in the deep fascia. Because it finally coursed like the radial artery in the forearm and the palm, we defined the variant artery as superficial brachioradial artery (SBRA). In the cubital region a little below the intercondylar line, the brachial artery gave off a small communicating branch to SBRA, and continued as the ulnar artery. CONCLUSIONS: We reported this unique variation and discussed its clinical and embryological implication.

[Superficial ulnar artery while harvesting a radial forearm flap]. / Artère ulnaire superficielle, découverte fortuite lors du prélèvement d'un lambeau antébrachial radial.

Forearm vascular anatomical variations are common and may have complications during flaps harvesting. This article describes the presence of an ulnar superficial artery, revealed while harvesting a radial forearm flap. The prevalence of this anatomical variation is between 0.7 and 9.4%. It may have important consequences while covering loss of substance with a radial forearm flap. Unknown, there is a risk of vascular injury which may lead to distal ischemia of the upper limb. Preoperative diagnosis can anticipate this risk and harvest a fascio-cutaneous flap centered on a perforator of this artery.