手掌分区和手掌动脉

目的：为手创伤动脉吻合提供解剖学基础。方法：将灌注15％～30％过氯乙烯的手标本分为六区。解剖手掌,完毕后,将手掌血管制成动脉铸型标本,观察动脉的分支、吻合及掌弓的类型。结果：手掌有掌浅弓、掌深弓、掌桡侧吻合和掌远侧吻合。掌浅弓位于手掌Ⅰ、Ⅱ、Ⅲ区;掌深弓位于手掌Ⅰ、Ⅱ区;掌桡侧吻合位于Ⅱ、Ⅲ、Ⅳ区;掌远侧吻合位于Ⅲ、Ⅳ、Ⅴ区。结论：手掌动脉弓和动脉吻合相互垂直,形成了手掌供血的三维动脉系统。手掌创伤修复时,应对手掌各区重要的动脉进行修复,力争恢复其结构和功能的完整性。     

掌浅弓、掌深弓的组成分支吻合及其临床意义

目的:研究掌浅弓、掌深弓的组成类型、分支及吻合,为临床手外科提供解剖学基础.方法:在78例手的铸型标本上观察掌浅弓、掌深弓的组成、分支及吻合.结果:(1)掌浅弓分5型:Ⅰ.尺动脉型由尺动脉的终支构成,其分支直接到示指、拇指,不与其它动脉的分支吻合,占19.2%(15例).Ⅱ.桡尺动脉型由桡动脉分支与尺动脉构成,占51.3%(40例).Ⅲ.尺动脉掌深弓型由尺动脉的终支和掌深弓构成,占15.4%(12例).Ⅳ.桡正中尺动脉型由桡动脉、正中动脉和尺动脉构成,占10.3%(8例).Ⅴ.无弓型没有掌浅弓,桡动脉掌浅支分支营养拇指、示指及中指桡侧半,尺动脉分支营养中指尺侧半、无名指、小指,占3.8%(3例).(2)掌深弓分2型:Ⅰ.完伞型掌深弓由桡动脉的终支与尺动脉或其它分支构成,占93.6%(73例).Ⅱ.非完全型掌深弓是桡动脉的终支不与其它分支吻合.占6.4%(5例).掌浅弓、掌深弓互相吻合且发出许多分支.结论:掌浅弓、掌深弓分支众多,吻合丰富,变异大,临床手术时应熟练掌握相关知识.     

虎口掌侧动脉背侧穿支蒂跨区供血皮瓣的解剖基础

目的　探讨虎口掌侧动脉背侧穿支形态学特征,为虎口掌侧动脉背侧穿支皮瓣设计提供解剖学基础。 方法　用30侧灌注红色乳胶的成尸手标本,通过巨微解剖、血管铸型等方法,重点观测：①虎口背侧营养血管的起源、走行与分布;②虎口掌侧动脉背侧穿支与虎口背侧血管的吻合特点。另1侧灌注红色乳胶的新鲜标本进行摹拟手术设计。 结果　虎口背侧血供属多源性,由虎口掌侧动脉（示指桡掌侧固有动脉、拇指尺掌侧固有动脉）背侧穿支和虎口背侧动脉（第1掌背动脉）分支供养。①第1掌背动脉恒定起自桡动脉,走行于第1掌骨间隙,分出桡侧、尺侧和中间3个终支,有桡神经浅支发出的同名指背皮神经伴行;②虎口掌侧动脉向虎口背侧发出尺侧、中间和桡侧穿支,与第1掌背动脉分支形成恒定的吻合,营养虎口背侧皮肤。 结论　以虎口掌侧动脉背侧穿支为蒂,可形成跨区域供血虎口背侧皮瓣转位修复示指近侧段、鱼际部和拇指软组织缺损。     

左,右手动脉形态的比较研究

成人上肢标本30对,经动脉灌注,解剖观测,比较研究了同一个体左,右手动脉的形态特点。结果表明,形态差异主要在手掌部,且以掌浅层动脉最明显。浅,深两层动脉的管径右手较粗者占多数,而掌浅弓为完全弓型者多见于左手,掌浅层动脉的支数左手较多,桡、尺动脉及其第一级分支间的吻合支也是左手多于右手,说明左手的侧副循环能力比右手强。     

手部血管的应用解剖学研究

对66侧(左31,右35)成人手的血管进行了系统的观察。平第三掌骨处掌浅弓外径1.79±0.5(1.0—2.7)mm;掌深弓1.4±0.29(0.9—1.9)mm。掌浅弓分支的变异观以小指尺侧动脉起端多见。掌深弓除传统介绍外尚见到由桡动脉和小指尺侧动脉分支所形成。并就指掌侧总动脉、指掌侧固有动脉局部位置及其有关变异结合实际应用进行了讨论。     

桡动脉掌浅支及掌浅弓变异1例

<正>桡动脉在桡骨茎突水平发出掌浅支,经舟骨结节尺缘穿鱼际肌实质或沿其表面下行至手掌中远端与尺动脉吻合形成掌浅弓,弓的凸侧发出指总动脉[1]至各手指。作者在临床手术中发现一桡动脉掌浅支变异,报道如下。,患者,女性,42岁,右手拇指开放性损伤致皮肤缺损,拟行桡动脉掌浅支皮瓣修复,术中见桡动脉于桡骨茎突水平尺侧发出掌浅支直径为1.1mm,有两伴行静脉,直径约0.7mm、0.8mm,行向舟骨结节远侧缘,穿拇短展肌实质深部约1mm,于肌肉内向远尺侧走行,行程1.5 cm即拐向尺侧与尺动脉分支吻合,在手掌根部形成弓状血管吻合,血管弓动脉,,     

指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣的应用解剖

目的为指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣提供系统翔实的解剖学依据。方法14只新鲜成人尸体手标本,灌注红色乳胶,手术显微镜下解剖观测手背和2～5指指背血管的走行、分布、吻合情况及外径。结果手指近、中节每侧各有1～7支间接背侧皮支,2～8支背侧皮支。手指近节中段、近节远段、中节近段或中段每侧较为恒定的存在一支较粗大的指固有动脉背侧皮支,皮支平均外径通常≥0.30mm。掌背动脉终末段和远端掌深弓穿支的指背分支在近节指背与指固有动脉背侧皮支交通。不同节段指固有动脉背侧皮支在指背外侧缘交互吻合,在指背外侧缘形成一条营养血管链。结论以指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣解剖简单、快捷,旋转弧长,利于修复手指中远节较大面积的软组织缺损。     

左手动脉异常一例报道

正常分布于手的动脉来源于尺、桡动脉的分支:桡动脉发出掌浅支与尺动脉的终末支吻合形成掌浅弓,掌浅弓发出小指掌侧动脉和三条指掌侧总动脉,指掌侧总动脉分别发出两条指掌侧固有动脉,分布于2~5指相对缘;桡动脉穿第一掌骨间隙处发出拇主要动脉(其分三支分布于拇指两侧和示指桡侧     

掌长肌缺如伴发自尺动脉的正中动脉吻合成掌浅弓1例

掌长肌缺如和掌浅弓组成的形式变异分别均早有记载 ,但右侧掌长肌缺如伴发自尺动脉的正中动脉吻合成掌浅弓的变异少见 ,作者在解剖一例 10岁男童标本时遇见 1例 ,现报道如下。右侧掌长肌缺如 ,掌腱膜近端附着于桡侧腕屈肌腱尺侧缘上 (图 1) ,其远端和左侧掌长肌未见异常。右侧正中动脉 ,在距肱骨内、外上髁连线中点下方 3.5ｃｍ处发自尺动脉桡侧 ,外径 2ｍｍ(图 2 ) ,穿经指浅、深屈肌间下行 2ｃｍ(距肱骨内、外上髁连线中点下方 5 .5ｃｍ)处与正中神经伴行于桡侧腕屈肌与指浅屈肌之间的深面 ,然后经腕管入手掌 ,达掌腱膜深面 ,正中神经的指…     

手掌侧浅层动脉的观察

本文观察了181例(成人73,儿童108)手掌侧浅层动脉。掌浅弓类型:尺动脉型(36.5％)、桡尺动脉型(50.8％)、正中尺动脉型(10.5％)、桡正中尺动脉型(2.2％)。前二者具有非常显著的年龄差异,成人尺动脉型为儿童的2倍以上,桡尺动脉型则反之。作者认为主要是由于大鱼际处受压所致。男性尺动脉型多于女性,也可能是该原因。掌浅弓的分支可为2～6支,其中4支者占53.0％、5支者占30.9％;按分支的排列形式,有并列型(61.3％)、共干型(26.0％)、间隔型(8.3％)和混合型(4.4％)。共干多出现在尺侧分支,而间隔多出现在桡侧大鱼际处。我们认为,后者可能也与该处易受压有关。掌浅弓分支在手指的分布率,从尺侧向桡侧递减。     

A morphometric study on the superficial palmar arch of the hand

The vascular anatomy of the hand is a complex and challenging area and has been the subject of many studies. Knowledge of the vascular patterns and diameters of the hand gained more importance with improvements in microsurgical techniques in reconstructive hand surgery. We evaluated 50 hands (26 left, 24 right) of 26 formalin preserved cadavers to determine the superficial palmar arch, its branches and contributing vessels with special attention to the diameters. The symmetry of the types was also evaluated in detail for the first time in the literature. Measurements were made with the help of a digital caliper. The diameters of the ulnar, radial and median arteries were taken at the level of the wrist while the common palmar digital arteries, hypothenar branches and the superficial palmar branch of the radial artery were measured at their origin. Two types of superficial palmar arch were found and defined as complete (43/50 hands) and incomplete arches (7/50 hands). The complete arches were divided into four subgroups and incomplete arches into three subgroups. Most cases were found at the complete AI group (17 hands). Comparison of the arterial diameters showed the ulnar artery was the dominant vessel of the palm. The diameters of the common palmar digital arteries were not different with regard to complete or incomplete arches and between both sides. It looks safe to sacrifice one of the radial or ulnar arteries in some arterial interventions including radial artery cannulation, radial forearm flap and radial or ulnar artery harvesting for bypass grafting if the arch is complete. But we still recommend the noninvasive tests like modified Allen test or Doppler ultrasonography, before performing an invasive arterial intervention. We propose the radiologists to incorporate the median artery into the Doppler dynamic test in particular the existence or the absence of anastomoses between radial and ulnar arteries.This study was accepted as an oral presentation in the “IX National Congress of Anatomists, 7–10 September 2005, Kusadasi, Turkey”     

Persistent median artery in the hand: a report with a brief review of the literature

We encountered a persistent median artery in the forearms and hands bilaterally in a 78-year-old Japanese male cadaver during dissection practice at Wakayama Medical University. The brachial arteries divided into the ulnar and radial arteries. The ulnar artery gave off the median and posterior interosseous arteries at the same point, although the anterior interosseous artery was not found. The median artery ran along the median nerve and bifurcated in the hand. In the superficial layer of the palm, one branch of the median artery ran to the ulnar side of the thumb, whereas the other passed to the second interdigital space. The ulnar artery reached the third and fourth interdigital spaces and the ulnar side of the little finger, and showed no anastomosis with the median artery in the superficial layer of the palm. The radial artery did not give off the superficial palmar branch. Therefore, the formation of the superficial palmar arch was incomplete. In the deep layer of the palm, the radial artery formed the deep palmar arch with the deep palmar branch of the ulnar artery and gave off the princeps pollicis artery. In the dorsum of hand, the radial artery passed over the first dorsal interosseous muscle to the index finger and communicated with the palmar pollical artery from the median artery in the first interosseous space. The present study reports an unusual variation of the persistent median artery in the hand and briefly reviews the literature about the median artery.     

Deep palmar arch patterns in Brazilian individuals

The deep palmar arch is very important in the blood supply to the hand. Consequently, the radial artery and the deep palmar arch were studied in 60 hands from 30 cadavers of adult Brazilian individuals, of both sexes. The cadavers belong to the Universidade Federal de São Paulo, Brazil. The hand arteries were injected with red stained latex neoprene the deep palmar arch was observed in 59 preparations (98.3%). The arch conformation was classified in two groups, according to the course of the radial artery through the interosseous spaces from the dorsal to the deep palmar region. In group I the radial artery passed through the first interosseous space, and was observed in 51 preparations (85.0%) in group II, the artery passed through the second interosseous space, and was observed in 8 preparations (13.3%). In each group the arches were subdivided according to the number and origin of the deep palmar branch. In group I the arch was formed by the radial artery anastomosing with one deep palmar branch in 41 cases (68.3%), and with two deep palmar branches in 10 cases (16.7%). These branches originated from the ulnar artery, ulnar proper palmar digital artery of the little finger or the common palmar digital artery of the fourth interosseous space. In group II the deep palmar arch was formed by the radial artery anastomosing with one deep palmar branch in 7 cases (11.7%) and in only one case (1.7%) with two deep palmar branches. Knowledge of the arterial variations is very important for surgical procedures in the palmar region.     

Report of a rare human variation: absence of the radial artery

A case of unilateral absence of the radial artery is reported. The arterial system of the specimen was developmentally primitive with the anterior interosseous artery the chief blood supply to the forearm and hand. A "superficial ulnar artery" of small caliber supplemented the supply of the hand. Three large branches of the anterior interosseous artery supplied the hand with the lateral terminal branch replacing the radial artery distal to the wrist. The superficial palmar arch was formed by an anastomosis of the media and lateral terminal branches of the anterior interosseous artery. No deep palmar arch was present, but three palmar metacarpal arteries arose from a perforating artery which branched from a large dorsal branch of the anterior interosseous artery. The median artery was of small caliber and could not be traced beyond the midforearm. Based on this specimen and a review of other forearm and hand arterial variations, it is postulated that the ulnar artery may developmentally precede the median artery.     

Multiple variations of the arterial pattern in upper extremities: A case report and embryological pathogenesis

During a routine dissection at the Department of Anatomy, Collegium Medicum, Jagiellonian University, one cadaver was found to have multiple variations of the arteries of the upper limbs. The variations pertained to the course of the brachial artery as well as to its distribution. An unusual formation of the superficial palmar arch was observed in both upper limbs. The anatomical peculiarities encountered included: in the left upper limb—the brachioradial artery, which formed the superficial palmar arch by turning to the palmar side of the hand and connecting with the ulnar artery and in the right upper limb—a subscapular‐circumflex humeral‐deep brachial trunk that correlated with a high division of the brachial artery (in the upper third of the biceps brachii muscle), a large anastomosis between the radial and the ulnar artery, the presence of a persistent median artery, and the unusual formation of the superficial palmar arch, which was created by the median, ulnar, and radial arteries. In this report, we will trace the path of the axillary artery and its branches in detail and emphasize its embryological significance. Clin. Anat. 26:1031–1035, 2013. © 2012 Wiley Periodicals, Inc.     

A Study of Complete Superficial Palmar Arches Formed Entirely by Ulnar Artery

Superficial Palmar Arch is an arterial arcade and a dominant vascular structure in the palm. It is defined as the anastomosis between the superficial branch of the ulnar artery and supericial palmar branch of the radial artery. In ulnar dominant complete superficial palmar arch, the ulnar artery does not anastomose with radial artery and it terminates by supplying thumb and index finger. In the present study, this type of variation was found in 50% of the hands. This is in contrast to the classical superficial palmar arch normally described where the arch is completed on the radial side by superficial palmar branch of radial artery. In accordance with the present study, a feature that is present in 50% of the specimens cannot be called as a variation. In these cases, without an efficient collateral circulation, ulnar artery occlusion may cause claudication and gangrene in the digits and has clinical significance.     

肘关节动脉血液供应的初步观察

本文研究了57侧肘关节动脉的血液供应。动脉起点以前、后支起始位置的变异较常见,且以尺返动脉居多。尺侧上副动脉和肱深动脉的共干是仅有的一种形式。个别动脉的本干、前支和后支可以为2支。明显的肘前和肘后两网由纯关节支和肌关节支组成,但两者在形态和功能上不如膝关节明确和重要。网的组成有主次来源和层次关系。各局部动脉网亦不发达,存有相对的乏血管区。肘前髁上和滑车上水平血管吻合丰富,围绕肘后二沟一窝呈“H”形的动脉网为其特征,连接左右纵干的横干所在髁水平,亦是血液供应最丰富的部位。可将动脉分成3组,两侧动脉口径和起点高度的差异不明显,但动脉口径之间和起点高度之间仍有规律可循。各动脉前、后支在口径和分布范围上的互补作用比较明显。