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segment. Ideally, a single end-to-end primary arterial repair arch. The ulnar artery appears to be the main feeding
of the ulnar digital artery can obviate the need for two vessel. The ability to reconstitute the arterial flow when
[1]
anastomotic sites, as in the case of vein grafting. revascularizing the thumb using the palmar arch or radial
digital artery of the index finger depends on the anatomic
A classic morphology of the complete superficial palmar
arch is formed by the superficial palmar branch of configuration of the superficial palmar arch. The surgeon
the ulnar artery and the superficial palmar branch of the should always be aware of the variations in the superficial
radial artery. Superficial and deep palmar arches of the palmar arch before proceeding, and the expendability of
[1]
hand, formed by the radial and ulnar arteries, provide the superficial palmar arch or the radial digital artery
the dominant blood supply to the hand, with an intricate branch must be established to avoid ischemia of adjacent
network of collateral flow. The superficial palmar arch is digits. If the anatomy of the superficial palmar arch is
classified into two categories: complete or incomplete. normal [Figure 8], then the palmar arch or the radial
The latter is formed when the anastomoses between the digital artery of the index finger can be safely transferred
radial and ulnar superficial vessels constituting the arch distally to the ulnar digital artery to revascularize the
are absent. [2] thumb [Figure 9]; however, the possibility of using a
reverse radial forearm flap to resurface the palmar or
It is important for surgeons dealing with reconstructive dorsal defect associated with these types of injury may
hand surgeries and restoration of the functional anatomy be compromised. Richard and Goldner have discussed
of hand to understand how the pattern of the superficial transposing the digital neurovascular bundle in patients
palmar arch can vary. Several cadaveric and radiographic who have experienced a crush injury of the digits. [4]
studies have revealed enormous variability in the Other methods used to revascularize such injuries,
vascular anatomy of the deep and superficial palmar include reconstructing the injured segment with vein
[3]
arches. Conventionally, the superficial palmar branches grafts harvested from the distal third of the forearm,
of the ulnar and radial arteries form the superficial palmar

Figure 6: The superficial palmar arch and digital vein from the index
finger were used to revascularize the thumb
Figure 5: C-arm picture demonstrating skeletal fixation with Kirschner wires

Figure 7: Postoperative picture following revascularization Figure 8: Schematic depicting the normal superficial palmar arch anatomy

Plast Aesthet Res || Vol 1 || Issue 1 || Jun 2014 39