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Updated: May 23 2021

Blood Supply to Hand

4.5

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Images
https://upload.orthobullets.com/topic/6007/images/arches.jpg
https://upload.orthobullets.com/topic/6007/images/superficial arch close.jpg
https://upload.orthobullets.com/topic/6007/images/digital artery and nerve.jpg
https://upload.orthobullets.com/topic/6007/images/deep arch close.jpg
  • 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
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