During the first weeks of intrauterine development, the median and anterior interosseous arteries are the main sources of blood supply to the hand. The persistent median artery (PMA) is an embryological remnant considered an anatomical variation. There are numerous clinically important anatomical variations of the arterial pattern within the upper limb, which might refer to an atypical number, origin or course of the arteries The ulnar and radial arteries continue through the forearm to the hand and then establish the superficial and deep palmar arches The interosseous trunk arises from the ulnar artery and divides into an anterior and a posterior branch. The brachial artery at the elbow bifurcates into the radial and ulnar arteries. There was no adverse reaction to the contrast.
It was inferred that the preserved perfusion of the hand ( Figure 4) without the need for anastomosis of the ulnar or the radial artery was secondary to the presence of the anatomical variant diagnosed in the scan ( Figure 5). The imaging study showed a median artery originating as a continuation of the anterior interosseous artery ( Figure 2) and ending in the palm with an incomplete superficial palmar arch ( Figure 3). Therefore, an upper left limb angiotomography was requested for further evaluation. Interventional radiology was not available at the time for angiography.
However, due to strong pulses and adequate coloration of the hand and taking into account that the window for arteriorrhaphy was over, ligation of both radial and ulnar arteries was performed. A second surgery was performed by the plastic surgeons five days later. It was not necessary to intervene on vascular lesions due to the adequate perfusion of the hand. The patient improved his general condition and was followed daily by the plastic surgery service. Wound in the distal third of the left forearm (red arrow) with a complete section of radial and ulnar arteries.
0 kommentar(er)
