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Case Report Plastic and Aesthetic Research

A rare case of bilateral absence of distal

ulnar artery

Jung Ho Lee, Rock Kuen Ju, Young Joon Jun, Young Jin Kim

Department of Plastic and Reconstructive Surgery, College of Medicine, Catholic University of Korea, Seoul 110758, South Korea.
Address for correspondence: Dr. Jung Ho Lee, Department of Plastic and Reconstructive Surgery, Catholic University of Korea, 327 Sosa-ro,
Wonmi-gu, Bucheon-si, Gyeonggi-do 420717, South Korea. E-mail: tfm0822@catholic.ac.kr

ABSTRACT
It is fairly common to find anatomic variations and anomalies in the arterial pattern of the upper
extremities. However, a complete absence of the distal ulnar artery bilaterally is extremely rare. During
preoperative assessment for a radial forearm free flap, we accidentally discovered bilateral distal ulnar
artery agenesis. In this article, the clinical implications of this variation are discussed, along with a
review of the literature.
Key words:
Forearm free flap, ulnar artery, variation

INTRODUCTION CASE REPORT

The arterial patterns in the upper extremity have received A 58‑year‑old male was referred to the Department
attention in the field of clinical anatomy due to their of Plastic and Reconstructive Surgery for management
high variability. Mccormack et al. studied 750 upper of squamous cell carcinoma of the tongue. Magnetic
[1]
limbs of cadavers and found anomalies of the brachial, resonance imaging showed a 2.5 cm × 1.8 cm × 1 cm
radial, or ulnar artery in 112 cadavers. The radial artery sized enhancing soft tissue mass in the tongue, and the
was the most involved (81.3%), followed by the brachial patient was scheduled to undergo partial glossectomy.
[2]
artery (12.2%). Coleman and Anson showed direct
continuity between the ulnar artery and superficial palmar We decided to reconstruct the patient’s tongue using
arch and the dominance of the ulnar artery in the wrist. a radial forearm free flap. Preoperative Allen’s test
[3]
Keen noted that when the ulnar artery was larger than demonstrated dominance of radial artery bilaterally. An
the radial artery at the elbow, the anatomical relationship arteriography was performed to map the vasculature
was usually reversed at the wrist. Several other studies of the hand, and it showed a gradually narrowing ulnar
have also reported anatomical variances of the arteries in artery in the right upper limb that vanished in the distal
the forearm and hand. [4,5] However, bilateral absence of the 2/3 of the forearm after branching off interosseous
distal ulnar artery and superficial palmar arch is extremely branches. In addition, the superficial palmar arch was
rare. absent, and the deep palmar arch was filled by radial
artery alone [Figure 1]. The angiogram of left upper limb
We report a case of bilateral absence of the distal revealed symmetrical findings.
ulnar artery, which was accidentally discovered during
preoperative evaluation for a radial forearm free flap. Due to the anatomical variation of ulnar artery in the
forearm, the patient underwent reconstruction of the
Access this article online tongue using a free flap from anterolateral thigh and the
Quick Response Code: patient was discharged home 2 weeks after the operation
Website: without any complications.
www.parjournal.net
DISCUSSION
DOI:
10.4103/2347-9264.153205 The ulnar artery is the main provider of blood supply to
the hand via the superficial palmar arch. The superficial
[6]

Plast Aesthet Res || Vol 2 || Issue 2 || Mar 13, 2015 79