Source Arteries Radial artery runs between brachioradialis and FCR enters the dorsum of the carpus by passing between FCR and APL/EPB tendons (in the snuffbox) gives off superficial palmar branch (communicates with superficial arch) finally passes between 2 heads of 1st dorsal interosseous to form the deep palmar arch Ulnar artery runs under flexor carpi ulnaris lateral to ulnar nerve at the wrist enters the hand through Guyon's canal lies on the transverse carpal ligament Supplemental arteries anterior interosseous artery posterior interosseous artery median artery (occasionally) Superficial Arch Anatomy deep to palmar fascia distal to the deep arch surface marking at the level of a line drawn across the palm parallel to the distal edge of the fully abducted thumb Blood supply predominant supply is ulnar artery minor supply from superficial branch of radial artery Branches of superficial arch (from ulnar to radial) 1st branch is the deep branch that provides the minor supply to the deep palmar arch 2nd branch is the ulnar digital artery of the little finger the proper digital artery to the ulnar side of the little finger arises directly from the superficial arch 3rd, 4th, 5th, and 6th branches are the common palmar digital arteries in the palm, the digital arteries are volar to the digital nerves in the digits, the digital arteries are dorsal to the digital nerves in the digits, the neurovascular bundle is volar to Cleland's ligament multiple branches to intrinsic muscles and skin The superficial arch is complete (branches to all digits) in 80% of individuals Deep Arch Anatomy deep to the flexor tendons (FDS, FDP) proximal to the superficial arch at the level of the base of the metacarpals surface marking 1 fingerbreadth proximal to a line drawn across the palm parallel to the distal edge of the fully abducted thumb 1 fingerbreadth proximal to the superficial arch Blood supply predominant supply is the deep branch of the radial artery minor supply from the deep branch of the ulnar artery Branches of the deep arch (from radial to ulnar) princeps pollicis runs between 1st dorsal interosseus and adductor pollicis branch to the radial side of the index finger the proper digital artery to the radial side of the IF arises directly from the deep arch branches to the 3 common digital arteries in the 2nd, 3rd, and 4th web spaces The deep arch is complete (branches to all digits) in 97% of individuals Anatomic landmarks of the arches Arch Karplan's Cardinal line Distal Wrist Crease Superficial 15mm distal 50mm distal Deep 7mm distal 40mm distal Digital Arteries Common digital arteries arise from the superficial palmar arch Divide into proper digital arteries at the web spaces Gives dorsal branches distal to the PIP joints Dominant arteries are found on the median side of the digit (closer to midline) in the index finger, the ulnar digital artery is dominant in the little finger, the radial digital artery is dominant in the middle and ring fingers, ulnar and radial digital arteries are dominant respectively, but dominance is less obvious Dorsal Arteries Blood supply posterior interosseous artery dorsal perforating branch of anterior interosseous artery Form a dorsal carpal arch which gives rise to dorsal metacarpal arteries useful for dorsal metacarpal artery flaps 1st and 2nd dorsal metacarpal artery are more consistent than 3rd and 4th Veins Deep veins veins follow the deep arterial system as venae comitantes Superficial veins found at the hand dorsum contribute to the basilic and cephalic vein system