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     

拇指掌侧固有动脉的显微解剖

在30例上肢标本,观察拇指桡侧、尺侧的掌侧固有动脉,两侧的动脉为拇主要动脉的分支,占70％;拇指尺侧的动脉为掌浅弓的分支,占30％;拇指桡侧的动脉为掌浅弓的分支,占20％;其余10％即为掌浅弓与拇主要动脉的吻合支。拇指桡、尺侧固有动脉的外径于掌指关节平面处为1.35±0.05mm,于指间关节平面处为1.12±0.06mm;两侧固有动脉主于沿拇长屈肌腱腱鞘两侧行向远端时,沿途分支有腱鞘外动脉及腱鞘内动脉的分支。本文讨论了临床意义。     

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.     

拇、示指动脉的分型及其临床意义

目的：对拇指、示指的血供来源进行分型，为手外科提供解剖学基础。方法：在78例手部动脉铸型标本上观察拇指、示指主要动脉的来源。结果：根据拇指、示指血液供应的主要来源将其分为3型：Ⅰ型（拇主要动脉型）主要由拇主要动脉分支营养拇指、示指。根据示指桡掌侧固有动脉的来源，又将其分为3个亚型（掌浅弓型、掌深弓型、掌浅、深弓型），掌浅弓型：示指桡掌侧固有动脉从掌浅弓发出，占总数的52．56％（41例，左22例，右19例）；掌深弓型：示指桡掌侧固有动脉从掌深弓发出，占总数的30．77％（24例，左8例，右16例）；掌浅、深弓型：示指桡掌侧固有动脉由掌浅弓和掌深弓共同发出，占总数的5．13％（4例，左3例，右1例）。Ⅱ型（桡动脉掌浅支型）主要由桡动脉掌浅支分支营养拇指、示指，占总数的8．97％（7例，左5例，右2例）。Ⅲ型（指掌侧总动脉型）主要由指掌侧总动脉分支营养拇指、示指，占总数的2．56％（2例，右2例）。结论：根据拇指、示指血液供应来源不同分为拇主要动脉型、桡动脉掌浅支型和指掌侧总动脉型。其中拇主要动脉型又分为掌浅弓型、掌深弓型和掌浅、深弓型三种亚型。     

胎儿手部血供的应用解剖

目的 为开展宫内胎儿先天性并指手术提供解剖学依据.方法 制作8例24～32周正常胎儿上肢血管铸型标本,观察手部的掌浅弓、掌深弓及指掌侧固有动脉的来源、分支及吻合情况.结果 胎儿手部的血供主要来源于掌浅弓和掌深弓,手指在指蹼处的血供主要来源于指掌侧总动脉、掌心动脉及掌背动脉.结论 胎儿手部的血供是非常丰富的,为制作胎儿先天性并指手术皮瓣提供良好的解剖学基础.     

手掌部动脉的构筑

本文在手术显微镜下,观察和测量了50侧成人手掌部的动脉。手掌部的动脉,以掌浅层动脉、掌深层动脉和手背动脉形成3个主要血管层次。各层次间的吻合有:1.边缘吻合:位于手掌桡侧和尺侧缘,有浅,深2组。2.中央吻合,包括掌侧浅、深层间的直接交通支和间接交通支;掌侧和背侧间的近侧穿支、掌骨间隙穿支和远侧穿支。掌深弓及分支住手掌动脉构筑中居中间联系位置,对手掌部侧副循环的调节有重要作用。根据Poiscuille定律的流量公式,结合手掌动脉的形态特点推论,手掌部动脉的血液灌流,浅层以尺动脉为主,深层以桡动脉为主;边缘吻合的血液是从掌侧流向背侧;中央吻合的血流主要来自掌深弓及其分支。手掌部动咏的配布存在优势区域。深弓区优于浅弓区和手背动脉网区;中央吻合优于边缘吻合;边缘深层吻合优于浅层吻合。本文还讨论了指动脉的配布。     

桡动脉掌浅支粗大合并分支异常一例

双侧掌浅支粗大合并行程异常及分支变异者比较少见。作者在解剖一例成年男尸时发现双侧桡动脉掌浅支粗大合并行程异常同时伴有分支变异。 左侧桡动脉的掌浅支自桡骨茎突上方0.85cm处发出(见附图)。发支后的桡动脉干外径为2.00mm。掌浅支起始部外径1.92mm,该支贴鱼际肌表面的筋膜下行达手掌与尺动脉终支吻合成掌浅弓。掌浅弓属桡尺动脉型,位置正常,弓之最细处外径为1.58mm。掌浅弓在拇短屈肌下缘发出一长为0.50cm,外径为1.54mm的短支,即拇主要动脉。该动脉随即分为两支:一支为拇指桡掌侧动脉,走行于拇指掌面的桡侧缘;另一支是拇指尺掌侧动脉和示指桡掌侧动脉的共干支,继行2.00cm后,于拇收肌下缘处即分为上述两支。分别至拇、示指掌面的相对缘。另外。桡侧两条指掌侧总动脉共干发自掌浅弓。     

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,,     

指掌侧固有动脉的应用解剖

目的：通过对指掌侧固有动脉的掌侧分支分布情况的研究,为临床上取手指掌侧皮瓣修复手指提供解剖学依据。方法：通过对手指血管进行灌注,解剖及测量指掌侧固有动脉掌横支与皮纹的距离和管径。结果：近侧掌横支距皮纹为(6．16±1．51)mm,外径为(0．4l±0．08)mm。中间掌横支距皮纹为(4．34±1．40)mm,外径为(0．40±0．09)mm。远侧掌横支距皮纹为(5．98±2．30)mm,外径为(0．42±0．09)mm。近侧掌横支与中间掌横支之间的距离为(26．62±2．08)mm,中间掌横支与远侧掌横支之间的距离为(10．33±2．77)mm。结论：在手指修复取皮瓣时,要考虑掌横支的特点及分布情况。     

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…     

An unusual termination of the ulnar nerve in the palm.

During the dissection of the left forearm and hand of a 57-year old male cadaver fixed in 10% formalin, it has been noted that the medial proper palmar digital nerve to the little finger arose from the dorsal branch of the ulnar nerve, instead of the superficial branch of the same nerve. The dorsal branch, given off by the ulnar nerve in the forearm, coursed distally and dorsally deep to the flexor carpi ulnaris muscle. Some 2 cm proximal to the pisiform, it pierced the deep fascia on the posteromedial side of the muscle to become superficial. At this point, one of the three branches given off travelled distally on the palmar-ulnar side of the hand to the skin of the little finger. There were connections between this branch and the branches of the superficial branch of the ulnar nerve which innervated the skin of the hypothenar eminence. Further, another branch of the superficial branch of the ulnar nerve passed under the fibrous arch of the flexor digiti minimi brevis muscle origin and the opponens digiti minimi muscle to re-unite with its parent nerve.     

Muscle variations and abnormal branching and course of the ulnar nerve in the forearm and hand

During dissection of the right forearm of a 27-year-old female cadaver, variations in the form and insertion of the palmaris longus muscle were observed. The tendon of the palmaris longus muscle, which demonstrated a centrally placed belly, split into two tendons: one inserted into the palmar aponeurosis and the other into the proximal part of the flexor retinaculum. Additionally, we found an accessory muscle extending between the flexor retinaculum and the tendon of the abductor digiti minimi muscle. This accessory muscle was located deep to the ulnar artery but superficial to the superficial and deep branches of the ulnar nerve at the wrist. Finally, an aberrant branch of the ulnar nerve was identified in the forearm; it traveled distally alongside the ulnar artery and in the palm demonstrated communications with common palmar digital nerves from the ulnar and the median nerves. No variations were observed in the contralateral upper limb.     

小指对掌肌腱弓的解剖学研究

目的探讨Guyon管以远尺神经深支卡压征的解剖学基础。方法对20例新鲜成人上肢标本腕部进行显微解剖，肉眼及镜下观测腕部尺神经分支与周围组织的关系。结果尺神经穿出Guyon管后进入小指对掌肌浅、深两头和钩骨钩之间的间隙，该间隙可分为顶、底和桡侧壁，有一个入口和一个出口，暂称其为小指对掌肌间隙。小指对掌肌浅头腱性起点的近侧缘锐利，呈腱弓样，存在率100％，暂称其为小指对掌肌腱弓。结论小指对掌肌腱弓可以卡压尺神经深支，引起除小鱼际肌以外的尺神经支配的所有手内在肌的功能障碍。     

Unusual vascularization and nerve supply of the fifth finger.

During a dissection course, an unusual variation in vascularization and nerve supply of the fifth finger of the right hand was found in a 73-year-old human male cadaver. The proper digital palmar artery arose from the superficial branch of the ulnar artery distel to the Guyon's canal. The proper digital palmar artery coursed first palmar to the ulnar nerve then between the abductor minimi and flexor digiti minimi muscles to reach the ulnar side of the fifth finger. Besides this, the ulnar border of the fifth finger was supplied on its palmar side by the dorsal branch of the ulnar nerve, which gave off two tiny twigs for the sensory innervation on the dorsal side of the same finger.     

Case report of a new variant of double incomplete superficial palmar arch

A rare, unique and previously non-described form of duplicated incomplete superficial palmar arch is reported in the right hand of a male cadaver. The two incomplete arches were formed from the continuation of two terminal palmar branches of the ulnar artery in the distal third of forearm that were connected by a small transverse artery superficial to the flexor retinaculum. Both arches had no contribution from the radial artery. The palmar digital branches from the lateral arch supplied the lateral two-and-a-half fingers, while those from the medial arch supplied the medial two-and-a-half fingers. The thumb and index had additional blood supply from the princeps pollicis and radialis indicis branches of radial artery. The deep palmar arch was entirely formed by the radial artery with no contribution from the ulnar artery. Previous reports on various patterns of superficial palmar arch are highlighted, and the anatomical and clinical importance of the new pattern are discussed.     

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.     

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”     

Arterial supply of the thumb: Systemic review

We offer a complete systemic review of the anatomy of arteries of the thumb, including their sources in the first web space. Eleven studies were selected from the PubMed, Medline, Embase, Scopus and Ovid databases. Data about each artery of the thumb were obtained; in particular, the incidence and dominance of each of these arteries were calculated. The ulnopalmar digital artery of the thumb (UPDAT) was found in 99.63%, the radiopalmar digital artery of the thumb (RPDAT) in 99.26%, the ulnodorsal digital artery of the thumb (UDDAT) in 83.39%, and the radiodorsal digital artery of the thumb (RDDAT) in 70.38%. The sources for the thumb arteries are the first palmar metacarpal artery (for UPDAT in 63.15%, for RPDAT in 78.88%, for UDDAT in 56.95% and for RDDAT in 41.48%), the first dorsal metacarpal artery (for UPDAT in 20.54%, for RPDAT 2.53%, for UDDAT in 20.62%, and for RDDAT in 4.81%) and the superficial palmar arch, either complete or incomplete (for UPDAT in 25.57%, for RPDAT in 23.04%, for UDDAT in 0%, and for RDDAT in 5.19%). The dominant source could be identified in 88.2% of cases: the first palmar metacarpal artery (66.2%), the first dorsal metacarpal artery (15.5%) and the superficial palmar arch, complete or incomplete (8.2%). Four arteries usually supply the thumb. Any artery in the first web space can be a source for the thumb arteries. We propose a new classification of the arteries of the hand, dividing them into three systems (superficial palmar, deep palmar and dorsal system), and suggest that the term “princeps pollicis artery” be reconsidered and systemic anatomical terms of the thumb arteries preferred. Clin. Anat. 30:963–973, 2017. ©2017 Wiley‐Liss, Inc.     

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.