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Hand Trauma – Soft Tissue
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
In a similar manner if there is a flexor tendon injury in the proximal palm there is a higher degree of urgency for exploration and repair as here the tendons lie deep to the superficial palmar arch and if this is damaged the patient will benefit from a revascularisation of this structure.
Surgery of the Peripheral Nerve
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ravikiran Shenoy, Gorav Datta, Max Horowitz, Mike Fox
The tendon of palmaris longus (absent in about 10%) is easily seen and palpated by opposing the thumb and little finger and then flexing the wrist to around 30°. The distal end of the tendon bisects the anterior surface of the carpal tunnel. Other useful landmarks include the thenar skin crease (running at the base of the thenar eminence) and the transverse skin crease of the wrist joint (running parallel to the joint line). The transverse wrist crease marks the proximal border of the flexor retinaculum. If the thumb is outstretched to 90°, a parallel line drawn across the palm in line with its distal border represents the surface marking of the superficial palmar arch: this is known as Kaplan's cardinal line (Figure 5.1).
Upper limb
Published in David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings, McMinn’s Concise Human Anatomy, 2017
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings
The artery continues into the palm as the superficial palmar arch (Fig.4.11); it extends no farther into the hand than the level of the web of the outstretched thumb. It is usually J-shaped; only in one-third of hands is the arch completed by union with the superficial palmar branch of the radial artery. The arch lies deep to the palmar aponeurosis, superficial to the long flexor tendons, and its digital branches run up the sides of the fingers, joining with corresponding vessels from the deep arch.
Spontaneous necrosis of a single digit: watershed necrosis
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Alain J. Azzi, Gabriel Bouhadana, Fanyi Meng, Peter G. Davison
Classically, the radial and ulnar arteries enter the hand and anastomose across the palm to form the superficial and deep palmar arches. Normally, the main supply of the deep palmar arch (DPA) is the radial artery, whereas the superficial palmar arch (SPA) is ulnar-dominant. The DPA usually branches to form the princeps pollicis and the radial digital artery of the second digit. The SPA gives off the ulnar digital artery of the fifth digit and the common palmar digital arteries in the second, third and fourth web spaces. Vascular redundancy and interconnections render the blood supply to the hand and digits robust. Examples include interconnections between the deep and superficial arches, between the palmar metacarpal arteries and the digital arteries, between the dorsal metacarpal arteries and the digital arteries, etc. Anatomical variations are common and do not usually pose a risk to digit blood supply due to this network of interconnections. We present a case of spontaneous ‘watershed’ necrosis of a single digit caused by arterial disease, a pathology that would have otherwise been benign in patients with normal anatomy. To our knowledge, this mechanism of digit necrosis has yet to be reported in the literature.
Axillary artery pseudoaneurysm and distal ulnar embolization in collegiate pitcher: a case report and review
Published in Case Reports in Plastic Surgery and Hand Surgery, 2018
Lohrasb R. Sayadi, Ajul Shah, Mustafa Chopan, James G. Thomson
Non-invasive and invasive studies of the right upper extremity were performed. On angiogram, the patient was found to have near complete occlusions of the ulnar and common interosseous artery and ulnar digital vessels of the superficial palmar arch. Interventional radiology was consulted to attempt aspiration of the emboli, which was unsuccessful. Trans-thoracic echocardiography was performed to investigate possible cardiogenic source of the patient’s emboli, which was negative. Hematological studies were preformed, and a hypercoagulable state was ruled out. Right upper extremity CTA showed a 5 mm axillary pseudoaneurysm, and it was hypothesised that the origin of the emboli to his distal hand was from this axillary pseudoaneurysm (Figures 1 and 2). The patient was started on tissue plasminogen activator (tPA) and heparin infusions through a brachial artery sheath. Non-operative management was only partially successful at improving perfusion as the ulnar artery and common interosseous artery opened, but the superficial palmar arch and digital vessels remained occluded (Figure 3). Doppler signal was detected throughout his right upper extremity, including his ulnar artery at the wrist and into the palmar arch and ulnar digital arteries. Radial and ulnar pulses were palpable. Surgery was then proposed, both for improving perfusion to the hand (thrombectomy, embolectomy, and potential vascular bypass), and for eliminating the presumed source of the initial embolus (axillary artery reconstruction).
Feasibility of distal transradial access for coronary angiography and percutaneous coronary intervention: an observational and prospective study in a Latin-American Centre
Published in Acta Cardiologica, 2023
Héctor Hugo Escutia-Cuevas, Marco Alcantara Melendez, Arnoldo Santos Jiménez-Valverde, Gregorio Zaragoza-Rodriguez, Antonio Vargas-Cruz, Juan Francisco Garcia-Garcia, Bayardo Antonio Ordonez-Salazar, Antonio Flores-Morgado, Guillermo Orozco Guerra, Diego Alvaro Renteria-Valencia
Another important characteristic of this technique is a proximal puncture of the short artery of the thumb and distally to the branch that irrigates the superficial palmar arch. An occlusion at this site maintains anterograde flow towards the superficial palmar arch, reducing the risk of developing retrograde thrombus in the proximal radial artery located in the forearm [8,9].