The deep palmar arch lies approximately 1 cm proximal to the superficial arch, deep to the flexor tendons and across the metacarpal base level. It is the terminus of the radial artery's dorsoradial course through the first dorsal web space. The deep arch primarily supplies the interossei and contributes to the common digital arteries distally. The Allen test assesses radial-ulnar collateral flow through both arches.
| Origin | Radial artery (primary — 95%) continuing from the dorsal first interosseous space, completed by the deep branch of the ulnar artery |
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The deep palmar arch is the primary supply to the interosseous muscles and is preserved during carpal tunnel release and distal radius ORIF. Injury to the radial artery in the anatomical snuffbox or deep arch can produce ischaemia of the first web space and thumb. Digital ischaemia after cannulation requires assessment of arch collateral flow.
Deep palmar arch compromise from radial artery harvest for coronary bypass in patients without adequate ulnar-to-arch collateral producing finger ischaemia.
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