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Editorial
Dr. Patnaik. V.V. Gopichand
A Study of Histology of Human Ductus Arteriosus-Before and After Birth
Baig Mirza Mujahid and Gaikwad P.G.
Department of Anatomy, Dr. V.M. Medical College, Solapur. INDIA
Patterns of Talar Articular Facets of Egyptian Calcanei
Saadeh F.A.1 Fuad A.H.,2 Mahmoud S.M.I.,2 Marwan E.E.1
1Department of Human Morphology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
2Department of Anatomy, University of Alexandria, Alexandria, Egypt
Address for Correspondence
Anteversion In Adult Indian Femora
Nagar M, Bhardwaj R., Prakash R.
Department of Anatomy University College of Medical Sciences, Shahdara, Delhi-110095 India
Radial and Ulnar Deviation at the Wrist in Young Adult Females
Kakar S. and Kumar Dinesh
Department of Anatomy, Lady Hardinge Medical College, New Delhi ? 110 001 INDIA.
Sexing Of The Femora
Leelavathy N, Rajangam S, Janakiram S., Thomas IM,
Department of Anatomy, St. Johnﾁfs Medical College, Bangalore ? 34 INDIA.
Development of Secondary Sex Characters in Punjabi Jat-Sikh Boys.
Singh Z.
Department of Anatomy, G.G.S. Medical College, Faridkot, Punjab, INDIA.
A Comparative Study of Cervical Sympathetic Chain
Kalsey G.1, Mukherjee R.N.2 and Patnaik V.V.G.1
Department of Anatomy,1 Government Medical College Amritsar Punjab, 2Government Dental College Sunder Nagar, (H.P.), INDIA.
Role of Phreno-Esophageal Membrane And Mucosal Flaps in the Functioning of the Gastroesophageal Junction Morphologic And Microanatomic Study In Mammals Including Man.
Patnaik V.V.G. and *Mukerjee R.N.
Department of Anatomy, Govt. Medical College, Amritsar (Punjab) and * Govt. Dental College, Sundernagar (H.P.) INDIA.
Effect of Female Oral Contraceptives On Human Chromosomes And Its Role In Behavioural Changes In offsprings
Kumar Keshaw, Department of Anatomy, Institute of Medical Sciences B.H.U., Varanasi, India.
Teratogenic Effects of Intra-amniotic Vitamin A on Rat Fetus
Mohanty C, Singh G.,
Department of Anatomy, Institute of Medical Sciences, B.H.U. Varanasi. (U.P.), INDIA.
Teratogenicity of Acrolein in Rats
Mohanty C., Singh G., Das B.K.1, Saxena A.K.
Department of Anatomy & 1Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Bronchopulmonary Changes After Repeated Exposure To Cold Restraint Stress In Rats.
Bharihoke V., *Gupta M. and Gohil H.
Department of Anatomy, University College of Medical Sciences and GTB Hospital, Delhi-110095. INDIA.
*Department of Anatomy PGIMER Chandigarh.
Fatal anaphylactic shock due to novaglin injection: A case report.
Sahni Daisy, Jit Indar.
Department of Anatomy, Postgraduate Institute of Medical Education & Research, Chandigarh.
Anomalous Course of Radial Artery And A Variant of Deep Palmar Arch-A Case Report
Patnaik V.V. Gopichand, Kalsey G. Singla Rajan K.
Department of Anatomy, Government Medical College, Amritsar. Punjab, INDIA.
Penile Agenesis : A Case Report
Singh P, 1Singh R.J., Sood V, Sapra A.
Department of Anatomy and 1Surgery, Dayanand Medical College and Hospital, Ludhiana. Punjab INDIA.
Rare Cutaneous Branches of Transverse Cervical Artery : A Case Report
Koshy S, Vettivel S.K.
Department of Anatomy, Christian Medical College, Vellore, India.
Variations of Superficial Veins of Head & Neck
Yadav S, Ghosh S.K., Anand C.
Department of Anatomy, Dr. R.P. Govt. Medical College, Kangra at Tanda-176601 (H.P.) INDIA.
Superficial Palmar Arch Duplication-A Case Report
Patnaik V.V. Gopichand, Kalsey G., Singla Rajan K.
Departmet of Anatomy, Govt. Medical Collage, Amritsar, Punjab INDIA.
Missing Caecum-A Case Report
Kaushal S., Batra A.P.S., Kaur M.
1Department of Anatomy, Govt. Medical College, Patiala.
Surgical Incisions - Their Anatomical Basis Part 1 - Head And Neck
Patnaik V.V.G.*, Singla R.K.* and Bala Sanjus
Department of Anatomy, *Govt. Medical College, Amritsar (Punjab) and sGovt. Dental College, Amritsar (Pb.) INDIA.
Applied Anatomy of Fascial Spaces In Head and Neck.
Singh T.P., Bala Sanju, 1Kalsey G., 1Singla Rajan K.
Department of oral & Maxillofacial Surgery, Pb. Govt. Dental College, Amritsar.
1Department of Anatomy, Government Medical College, Amritsar. Punjab INDIA.
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Anat. Soc. India 49(1) 54-57 (2000)
Anomalous Course of Radial Artery And A Variant of Deep Palmar Arch-A Case Report
Patnaik V.V. Gopichand, Kalsey G. Singla Rajan K. Department of Anatomy, Government Medical College, Amritsar. Punjab, INDIA.
Abstract : An anomalous course of radial artery is reported. While origin and antebrachial course was normal distally consequent upon crossing deep to the long tendons in the anatomical snuff box, it passed onto the dorsal aspect of the wrist, and continued medially as lateral part of dorsal carpal arch. At the level of base of 2nd metacarpal, it turned distally to dip into the 2nd intermetacarpal space coursing between the two heads of 2nd dorsal interosseous muscle. In the palm, it formed deep palmar arch with deep palmar branch of ulnar artery. Its ontogenic, phylogenic and clinical aspects are discussed.
Keywords : Radial artery, Deep Palmar arch, Macaca Fuscata
Case report A very rare anomaly of unusual course of radial artery & a variant deep palmar arch in left superior extremity of a 50 years old male cadaver was encountered during the dissections carried out under a project, ﾁeﾁeArterial pattern of superior Extremity of human adult ? A Morphological Study.ﾁfﾁf in Anatomy Department, Govt. Medical College, Amritsar. The origin was typically of standard textbook description as one of the terminal branches of brachial artery, 2.5 cm distal to the intercondylar line opposite the head of the radius. It coursed normally in its antebrachial portion giving all its branches i.e. radial recurrent, muscular branches, palmar carpal and superficial palmar branches. The last of these passed superficial to thenar muscles and contributed to the formation of superficial palmar arch. Consequently the artery itself passed through the anatomical snuff box and reached the dorsal aspect of the wrist. There instead of continuing as first perforating branch between the 2 heads of first dorsal interosseous, it gave a small branch i.e. first dorsal metacarpal branch which in turn divided into arteria dorsalis pollicis and first perforating branch. The latter dipped into the first intermetacarpal space between two heads of the first dorsal interosseous muscle. The radial artery proper coursed beyond medially as radial half of dorsal carpal arch upto the base of second metacarpal. There the dorsal carpal branch arose which passed medially to anastomose with a similar branch of ulnar artery thus completing the dorsal carpal arch which gave off the third and fourth dorsal metacarpal branches. The radial artery further turned distally towards the interspace between second and third metacarpal. At the proximal end of this space it gave a second dorsal metacarpal branch which passed distally towards second interdigital cleft ; and then the radial artery dipped into second intermetacarpal space (at its proximal end) between the two heads of second dorsal interosseus to reach the palm (See Photograph-1). In the palm it emerged from the proximal end of second intermetacarpal space and coursed medially to complete deep palmar arch with superior deep palmar branch of the ulnar artery. (See Photograph-2). 
Photograph-1
Radial artery dipping at proximal end of 2nd Intermetacarpal space.
(ra - Radal artery, dca - dorsal carpal arch, II, III, IV Intermetacarpal arteries) 
Photograph-2
Variant deep palmar arch (dpa) Arrow pointing towards radial artery emerging at proximal end of 2nd Intermetacarpal space
Discussion
Morphology The branches of the radial artery at the wrist as described by Anson, (1966) are the dorsal carpal and the first dorsal metacarpal arteries. 1. Dorsal carpal branch arises from the radial artery, as it is crossed by the extensor pollicis longus tendon. It runs to the ulnar side of the wrist in the groove between the proximal and distal rows of carpals, passing deep to the tendons of the extensor carpi radialis longus and brevis muscles. Continuing ulnarwards, it anastomoses, either directly or by a number of small branches with the dorsal carpal branch of the ulnar artery and the posterior terminal branch of the anterior interosseous artery, forming the dorsal carpal arch. The dorsal carpal branch is large at its origin but diminishes towards the ulnar border of the hand; a complete arch is seldom formed. Dorsal carpal arch has a variable pattern, depending upon the size of the vessels entering into its formation. It usually provides the second, third, and fourth dorsal metacarpal arteries, which run distally in the hand on the corresponding dorsal interosseous muscles. 2. First dorsal metacarpal artery arises from the radial artery as it passes between the heads of the first dorsal interosseous muscle & divides into arteria radialis indicis & arteria princeps pollicis. In the palm, the radial artery takes part in formation of deep palmar arch by anastomosing with either superior or inferior or both deep palmar branches of ulnar artery. Coleman and Anson (1961) divided the deep palmar arch into two groups. Group 1 : Complete arch : It was further divided into 4 types :? Type A : The deep palmar arch is formed by the deep palmar branch of the radial artery which anastomoses with superior deep palmar branch of ulnar artery. Type B : The deep palmar branch of radial artery anastomoses with the inferior deep palmar branch of ulnar artery. Type C : Here both deep palmar branches of ulnar artery join the deep palmar branch of radial artery to complete the arch. Type D : It is formed by superior deep palmar branch of the ulnar artery which anastomoses with an enlarged superior perforating artery of the 2nd interspace. There is also a contribution from the 1st interspace which despite its small size help to complete the arch. Group II : Incomplete arch : It was found in 3% cases only and can be further divided into 2 types : Type A : The inferior deep palmar branch of ulnar artery anastomoses with the perforating artery of the 2nd interspace. The deep supply to the thumb and radial border of index finger is derived from deep palmar branch of radial artery. Type B : The deep arterial supply to thumb and the index finger are derivatives of deep palmar branch of radial artery which in turn anastomosis with a perforating artery of 2nd space. The arch is incomplete because the deep branch of ulnar artery ends in an anastomosis with perforating artery of 3rd interspace. The Reported Case : The deep palmar arch of present specimen does not fall under any of the types of above classification. In group I, Type A,B and C of this classification, the radial artery passes through first intermetacarpal space, while here it was passing through 2nd intermetacarpal space. In Type D, the superior deep palmar branch of ulnar artery anastomoses with enlarged superior perforating artery of 2nd intermetacarpal space with a small contribution from first interspace to complete the arch. Contribution from the first intermetacarpal space was conspicous by its obsence in the present case, as it was the radial artery proper and not an enlarged superior perforating artery which passed through 2nd intermetacarpal space. In group II type A of Coleman and Anson (1961), it is inferior deep palmar branch of ulnar artery which anastomosis with perforating artery of 2nd space and deep supply to thumb and radial border of index-finger is from deep palmar branch of radial artery, whereas in the present case, it was superior deep palmar branch of ulnar artery completing the arch and the deep supply to thumb and radial border of index finger was from superficial palmar branch of radial artery. In group II type B, deep arterial supply to thumb and radial border of index finger are derived from deep palmar branch of radial which anastomoses with perforating artery of 2nd space, deep palmar branch of ulnar anastomosing with perforating artery of 3rd space. This is also entirely different from the present case. Thus the deep palmar arch in the present limb, does not fall in any of the types of Coleman and Anson (1961) and so is unique in itself exhibiting a different type of deep palmar arch not reported in the literature earlier. Ontogeny Radial artery is the last of the forearm arteries to develop in comparative series, and its relation to the arterial supply in the hand is due to secondary anastomoses which it makes with the vessels originally present, whereby it has come to give origin to many branches formed before its appearance. Thus the first dorsal metacarpal and dorsalis pollicis are primarily digital branches from posterior interossesous branch of the first intermetacarpal space; the later is a branch of dorsal carpal arch and has become a portion of the radial by anastomosis of that artery with the arch. Similarly the portion of the radial artery that passes forwards between first and second metacarpals to join the deep palmar arch is primarily the first posterior perforating vessel which has secondarily become deep palmar apparent continuation of the radial and brought this vessel in direct continuity with the arch and given it the branches which originally arose from that vessel (Huber, 1930). (See Diagram-1) In the present specimen (Diagram-2) it is evident that the part of the radial artery which develops secondarily from dorsal carpal arch extends upto the origin of interosseous artery of 2nd inter metacarpal space (ﾁebﾁf in diagram-2) & part of the radial artery which usually develops from interosseous artery of first intermetacarpal space here developed from interosseous artery of second intermetacarpal space. (part c in diagram) and the part which normally develops from first posterior perforating artery; in this case developed from second posterior perforating artery (part d in the diagram) and then it joined deep palmar arch beginning from second intermetacarpal space and extending to fourth intermetacarpal space (part e in the diagram). The dorsalis pollicis and first posterior perforating branches which normally arise from radial 
Diagram-1 
Diagram-2 Normal development of radial artery Diagram-1 a = Radial artery b = Part of radial artery developing secondarily from dorsal carpal arch. c = Part of radial artery developing secondarily from interosseous artery of first inter metacarpal space. d = Part of radial artery developing secondarily from first posterior perforating artery. e = Part of radial artery developing secondarily from deep palmar arch f = First dorsal metacarpal branch of radial artery (originally branch of interosseous artery of first
inter metacarpal space). g = Dorsalis pollicis branch of radial artery (originally branch of interosseous artery of first inter metacarpal space). R Radial end of dorsal carpal arch, where radial artery anastomoses. Diagram-2 Development of radial artery in the present specimen a = Radial artery b = Part of radial artery developing secondarily from dorsal carpal arch c = Part of radial artery developing secondarily from interosseous artery of second inter metacarpal space. d = Part of radial artery developing secondarily from second posterior perforating artery. e = Part of radial artery developing secondarily from deep palmar arch. f = Interosseous artery of first inter metacarpal space. g = Arteria dorsalis pollicis, a branch of ﾁefﾁf in the present specimen h = First posterior perforating branch arising from ﾁef in the present specimen. R Radial end of dorsal carpal arch, where radial artery anastomoses. artery are arising in this case as branches of interosseous artery of first intermetacarpal space, the later being a branch of radial artery (if in diagram). Williams et al (1999), Hollinshead (1958), Lockhart et all (1959), Romans (1966), Anson (1966), Boyd et al (1956), Spalteholz, Massie (1944). Anson and Madhok (1952) and Thorek (1951) unanimously opined that that variations in carpal part of radial artery are very rare. None have mentioned of radial artery passage through second intermetacarpal space. However, Hollinshead (1958) recalls a few cases in which a part of radial artery passed superficial rather than deep to tendons of long muscles on radial side of wrist and that such a vessel may enter the palm more distally than usual by passing between first dorsal interosseous muscle and head of the second metacarpal, rather than between two heads of the muscle (however in the first intermetacarpal space only). All the above authors are silent about this rare type of presentation of the radial artery. Hence this variation is unique and no parallel to it was found in literature till date. Phylogeny It is pertinent here to quote Manners Smith (1911) who, while discussing a comparative study on the arteries of hand in primates concluded that many of the variations noted in man represent a retention or reappearance of primitive patterns. Nishi (1939) and Koch (1939) studied arterial arches of palm in rhesus monkeys and observed 3 deep palmar arches which are derived form the perforating branches of 2nd dorsal metacarpal artery. These findings read with the work of Ugawa et al (1985) on the arterial pattern of hand in primates (Macaca fuscata) are useful in solving the phylogenetic riddle in this case. In the primates, the 2nd dorsal metcarpal artery is the main artery assisting in the formation of deep palmar arterial arches. It is derived along with the first dorsal metacarpal artery from the radial artery which courses diagonally from a point a little beyond the styloid process of radius. The proximal perforating branch of 2nd dorsal metacarpal artery enters the palm at the base of 2nd intermetacarpal space by passing between 2 heads of origin of 2nd dorsal interosseous muscle to contribute to the catella volaris proximalis while its distal perforating branch enters the palm at the distal end of 2nd intermetacarpal space helping formation of catella volaris distalis. It is also interesting to note that superficial palmar arch of macaca fuscata is invariably radio-ulnar in type. The human deep palmar arterial arch corresponds to archus volaris profundus of primates which follows the course of deep branch of ulnar nerve and arises form catella volaris proximalis at the palmar aspect of 3rd metacarpal bone perforating the site of origin of oblique head of adductor pollicis muscle. The arch divides terminally into radial and ulnar branches. Mori (1959) stated that 2nd dorsal metacarpal artery is derived from descending radial artery whereas other dorsal metacarpal arteries arise from dorsal carpal rete. It is only 2nd dorsal metacarpal artery which descends the 2nd intermetacarpal space. From the forementioned facts, it is evident that the present case is a classic retention of atavistic pattern where the main artery dipped in the 2nd intermetacarpal space between the heads of 2nd dorsal interosseous as part of catella volaris proximalis of primates and contributed to the small deep palmar arch in a typical primate fashion of archus volaris profundus. Clinical Significance Iselin (1940), Nichols (1957), Boyes (1970) and Rank et al (1973) have thrown a flood of light on surgery of hands, but none of them encountered this type of anomaly, so all of them are silent on the clinical importance of this type of variation. However, probably a serious secondary haemorrhage might occur in this region if the surgeon has not anticipated a vessel of large caliber as of radial artery here. It is even more important during tendon transplant surgeries. References : 1. Anson, B. J. : Morrisﾁf Human Anatomy In : The cardiovascular system-Arteries and veins; Thomas M; Oelrich Eds. McGraw Hill Book Co; The Blackiston Division, New York, Toronto, Sydney, London: pp. 708-724 (1966).
2. Anson, B. J. and Maddock, W. G. : Callanderﾁfs Surgical Anatomy. In: The Hand-Palm region. 3rd Edn. W. B. Saunders Co. Philadelphia London : p. 831 (1952).
3. Boyd, J. D., Clark, W. E., Hamiliton, W. J., Yoffey, J. M. Zuckerman, S. & Appleton, A. B. : Textbook of Human Anatomy. In: CVS- Blood vessels. MacMillan & Co. Ltd., New York, London. pp. 341-46.(1956).
4. Boyes, J.H. Bunnelﾁfs Surgery of the hand. 5th Edition J.B. Lippincott Co Philadelphia. Toronto: pp. 1-704 (1970).
5. Coleman S. and Anson J.(1961) : Arterial pattern in hand-based upon a study of 650 specimens. Surgery Gynaecology and Obstetrics; 113 (4): pp. 409-424.
6. Hollinshead, W. H. : Anatomy for surgeons. The back and limbs. In : Elbow and Forearm - The Forearm, Vol. 3, Paul B. Hoeber, Inc. Med. Book Deptt. of Harper & Brothers, 49 East, 33rd street, New York 16 : pp. 415-416 (1958).
7. Huber, G. C. : Piersolﾁfs Human Anatomy. In: The vascular system. 9th Edn. Vol. 1, J. B. Lippincott Co., Philadelphia, Montreal, London: pp. 767-791 (1930).
8. Iselin, M: Surgery of the hand. In: Wounds. J & A Churchill Limited, 104, Gloucester place: pp. 1-105 (1940).
9. Koch, K (1939): Das Verhalten der Arterienbogen in der Vola manus and Planta pedis bei Affen. Z.Anat. EntwGesch, 110: pp. 81-87.
10. Lockhardt, R. D; Hamilton, G. F. and Fyfe, F. W. : Anatomy of the human body. In: Vascular system - systemic arteries. Faber and Faber Ltd., 24 Russell Square. London :pp 612-619 (1959).
11. Manner-Smith, T (1911): The limb arteries of primates. Journal of Anatomy and Physiology 45: pp.23-64.
12. Massie, G. : Surgical Anatomy. In : The upper limb. 4th Edn., J & A Churchill Ltd. 104, Gloucester Place, Portman sq. London, pp. 152-155 and 177-178 (1944).
13. Mori, M (1959) : On the arteries of the Macacus cyclopis. Folia Anatomica Japan 32: pp. 241-274.
14. Nichols, H.M: Manual of hand injuries. In ; Anatomy. The Year Book Publishers, Chicago: pp. 13-36 (1957).
15. Nishi, S. (1939) : Uber die Arterien der Affenhand. Ein Beitrag zur vergleichenden Angiologie. Japanese Journal of Medical Sciences, Part 1, Anatomy 7: pp. 81-97.
16. Rank, B.K.: Wakefield, A.R. and Hurston, J.T.: Surgery of repair as applied to hand injuries. In: Surgical Anatomy of hand.4th Edition Churchill Livingstone, Edinburgh London:pp.22-23 (1973).
17. Romanes, G. J: Cunninghamﾁfs Textbook of Anatomy. In: the Blood vascular system-Arteries of the upper limb, E, W, Walls Eds. 10th Edn. Oxford University Press, New York, Toronto, London: pp. 885-893 (1964).
18. Spalteholz, W. : Hand Atlas of Human Anatomy. In: Arteries of the neck and arm. 7th Edn. Vol.II, J.B. Lippincot Co., Philadelphia and London: pp. 424- 435 (year not given).
19. Thorek, P.: Anatomy in Surgery. In : Superior Extremity-Arm-Brachial Region, 2nd Edn. J. B. Lippincott Co., Philadelphia, London, Montreal, pp: 702-708 (1951).
20. Ugawa, A and Ikeda, A (1985) : Study of arterial patterns of the hand in primates. Acta Anatomica 123: pp. 82-89.
21. Williams, P. L., Bannister, L. H., Berry, M. M., Collins, P., Dyson, M., Dussek, J.E., and Ferguson, M. W. J.: ﾁeGrayﾁfs Anatomyﾁf. In: Arteries of the limbs. 38th Edn., Churchill Livingstone, Robert Stevenson House, 1-3 Baxterﾁfs Place, Leith Walk, Edinburgh EHI, 3AF. New York, London, Tokyo, Madrid and Melbourne: pp. 1540-2 (1995).
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