REVISITATION OF THE VASCULAR ANATOMY OF THE LUMBRICAL AND INTEROSSEOUS MUSCLES

Functional outcome after transmetacarpal replantations and revasculari zations is discouragingly poor and often associated with a high incide nce of intrinsic-related complications. In order to explore the hypoth esis that intrinsic muscle ischemia may play a significant role, we re visited the vascular anatomy of the lumbrical and interosseous muscles . Six fresh-frozen cadaver hands were injected with latex-barium sulfa te, and dissections were performed focusing on the contributions of th e deep and superficial palmar arches and their branches to the intrins ic muscle vasculature. We found that the lumbrical muscles are supplie d from both their volar and dorsal surfaces by both the superficial an d deep palmar arches in both axial and segmental fashions. The dorsal and volar interossei receive their major blood supply from the deep ar ch and metacarpal arteries without any distinct pattern of axial or se gmental vessels. These minute vessels cannot be repaired and are not r econstituted even with arch reconstruction. Moreover, with injuries di stal to the arch, dissection of the digital arteries further disrupts this blood supply. These anatomic findings may have significant implic ations in clinical replantation and revascularization.