Anatomical variations of the superficial and deep palmar arches: an updated systematic review and meta-analysis.

BACKGROUND: The vascular supply of the hand comprises a complex network of vessels derived from the radial and ulnar arteries, which form the superficial and deep palmar arches (SPA and DPA). The purpose of the present study was to systematically evaluate the morphometry and anatomical characteristics of the SPA and DPA through a comprehensive meta-analysis of studies reporting extractable data on these arterial anastomoses. MATERIALS AND METHODS: Major online medical databases, including PubMed, Embase, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Content Connect, and the Korean Journal Database, were searched through September 2025 in accordance with PRISMA guidelines. Original studies with extractable data on the SPA and DPA were included, whereas case reports, reviews, and studies with incomplete data were excluded. Outcomes included prevalence, anatomical patterns, morphometric characteristics of the arches, and the presence of a persistent median artery reaching the palm. Study quality was assessed using the CATAM and AQUA tools. A total of 127 studies involving 13,339 upper extremities were included in the meta-analysis. RESULTS: The prevalence of a complete SPA was 75.05%. Complete SPAs were more frequent on the left side (53.36%), whereas incomplete SPAs were more frequent on the right side (54.02%). The pooled prevalence of a persistent median artery reaching the palm was 9.59%. In group I (complete SPA), type A (radioulnar, classical) was most prevalent (72.18%), whereas in group II (incomplete SPA), type B (ulnar type) was most prevalent (50.71%). The prevalence of a complete DPA was 95.95%. The most prevalent DPA pattern was type II, formed by the deep volar branch of the radial artery and the superior deep branch of the ulnar artery (60.22%). CONCLUSIONS: This study represents the most extensive and up-to-date evaluation of SPA and DPA morphometry and anatomy. Its findings may provide an important reference for clinicians, particularly orthopedic and vascular surgeons performing procedures in the upper extremity.