Surgical and radiologic anatomy : SRA · 2026
Variations in the formation of the superficial palmar arch and its relationship to Kaplan's cardinal line: a study in a central Indian cadaveric sample.
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Saini Vaibhav, Kazi Shahin M, Shrivastava Mayanka, Panda Dhiren Kumar
Аннотация
PURPOSE: The superficial palmar arch (SPA) is the main arterial supply of the palm and varies in the way it is completed. Knowledge of these patterns, and of the position of the arch relative to surface landmarks, is needed for safe carpal tunnel release and for procedures that sacrifice the radial or ulnar artery. We documented the SPA in a central Indian cadaveric sample and its relationship to Kaplan's cardinal line.
METHODS: Fifty formalin-fixed adult upper limbs were dissected. During the study period the department held 20 registered whole-body cadavers and, in addition, a number of upper limbs that had been received already separated from the trunk without an accompanying donor record; the number of limbs contributed by each source, and hence the number of individual donors represented among the 50 limbs, could not be established (see Methods and Limitations). The arch was classified by the Coleman and Anson method into complete (Group I, types A-E) and incomplete (Group II, types F-I) forms, and its position relative to Kaplan's cardinal line was recorded in each limb.
RESULTS: A complete arch was present in 41 limbs (82%; 95% CI 69.2-90.2%) and an incomplete arch in nine (18%). Type B (ulnar only) was the most common complete form (42%), followed by type A (34%) and type E (6%); types C and D were absent. Among incomplete arches, type F predominated (10%), with types G (6%) and H (2%) less frequent and type I absent. In every limb the arch lay distal to Kaplan's cardinal line.
CONCLUSION: The frequency of the complete arch is comparable to pooled international data. The constant position of the arch distal to Kaplan's cardinal line supports the use of this landmark as a distal reference for palmar incisions during carpal tunnel surgery, although, because only the categorical position of the arch was recorded, this finding does not by itself define a quantitative safety margin.
METHODS: Fifty formalin-fixed adult upper limbs were dissected. During the study period the department held 20 registered whole-body cadavers and, in addition, a number of upper limbs that had been received already separated from the trunk without an accompanying donor record; the number of limbs contributed by each source, and hence the number of individual donors represented among the 50 limbs, could not be established (see Methods and Limitations). The arch was classified by the Coleman and Anson method into complete (Group I, types A-E) and incomplete (Group II, types F-I) forms, and its position relative to Kaplan's cardinal line was recorded in each limb.
RESULTS: A complete arch was present in 41 limbs (82%; 95% CI 69.2-90.2%) and an incomplete arch in nine (18%). Type B (ulnar only) was the most common complete form (42%), followed by type A (34%) and type E (6%); types C and D were absent. Among incomplete arches, type F predominated (10%), with types G (6%) and H (2%) less frequent and type I absent. In every limb the arch lay distal to Kaplan's cardinal line.
CONCLUSION: The frequency of the complete arch is comparable to pooled international data. The constant position of the arch distal to Kaplan's cardinal line supports the use of this landmark as a distal reference for palmar incisions during carpal tunnel surgery, although, because only the categorical position of the arch was recorded, this finding does not by itself define a quantitative safety margin.