Unusual Anastomosis between Branches of the Ulnar Nerve (Kaplan Type Anastomotic Variant) – Case Report

The Kaplan anastomosis is a rare communication originally described between the superficial and dorsal branches of the ulnar nerve, distal to the ulnar tunnel, and in strict relation with the pisiform bone. It reveals, by its particular location, a formation of high clinical-surgical expressiveness. In this paper, we describe a Kaplan-type communication from a left upper limb with an unusual loop conformation between branches of the ulnar nerve in the pisiform bone.

Keywords
anatomy; cadaver; hand/surgery; ulnar nerve

Authorship

Kennedy Martinez Oliveira Address for correspondence Kennedy Martinez de Oliveira, M.D., Anatomy and Image Department, Federal University of Minas Gerais-UFMG, Av. Professor Alfredo Balena, 190, Zip Code 30130-100, Belo Horizonte/MG, Brazil (e-mail: kennedy.martinez@gmail.com).

Anatomy and Image Department, Faculty of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, BrazilUniversidade Federal de Minas GeraisBrazilBelo Horizonte, MG, BrazilAnatomy and Image Department, Faculty of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil

https://orcid.org/0000-0001-7998-4847

Gabriel das Chagas Benevenuto

Department of Basic Life Sciences (DCBV), Faculty of Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, BrazilUniversidade Federal de Juiz de ForaBrazilJuiz de Fora, MG, BrazilDepartment of Basic Life Sciences (DCBV), Faculty of Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil

https://orcid.org/0000-0002-8702-6259

Ana Clara Ferreira de Almeida

https://orcid.org/0000-0001-7014-1675

Daniel Gonçalves de Oliveira

https://orcid.org/0000-0002-7039-0820

Leonardo Braga Bueno

https://orcid.org/0000-0003-3449-1525

Maria Fernanda Carvalho Teixeira

https://orcid.org/0000-0002-4907-4444

Address for correspondence Kennedy Martinez de Oliveira, M.D., Anatomy and Image Department, Federal University of Minas Gerais-UFMG, Av. Professor Alfredo Balena, 190, Zip Code 30130-100, Belo Horizonte/MG, Brazil (e-mail: kennedy.martinez@gmail.com).

Conflict of Interests

The authors have no conflict of interests to declare.

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Figures

Figures (3)

Thumbnail

Fig. 1
Medial view of the forearm and hand. 01–tendon of the flexor carpi ulnaris muscle; 02–dorsal branch of the ulnar nerve; 03–medial division of the dorsal branch of the ulnar nerve, the filled arrow indicates the dissected segment and the interrupted arrow indicates the path associated to the pisiform bone and with fibromuscular tissue overlay; 04–intermediary division of the dorsal branch of the ulnar nerve; 05–lateral division of the dorsal branch of the ulnar nerve; 06–pisiform bone; 07–abductor digiti minimi muscle; A–anterior, and D–distal.

Thumbnail

Fig. 2
Volar view with slight displacement of the nerve structures as from the metal spatula. 03–completely dissected medial division of the dorsal branch of the ulnar nerve (double filled arrow) and in anastomosis at the midpoint between the ulnar nerve (08), the deep branch of the ulnar nerve (09) and the superficial branch of the ulnar nerve (the Kaplan anastomosis variant); 06–pisiform bone; 07–abductor digiti minimi muscle; 10–common palmar digital nerve; 11–proper palmar digital nerve; 12–motor branch for the palmaris brevis muscle; and 13–deep face of the palmaris brevis muscle, partially retracted from its origin or distal insertion M–medial and D–distal.

Thumbnail

Fig. 3
Sulcus in the pisiform bone (6) represented by the discontinuous black line in the sulcus and in the medial and anterior aspect of this bone; 03–Kaplan-type anastomosis (double filled arrow); 08–ulnar nerve; 13–deep face of the palmaris brevis muscle, partially retracted from its origin or proximal insertion; 14–deep branch of the ulnar artery; asterisk (*) – surgical instrument pulling the ulnar artery as from its adventitia; M – medial, and D – distal.

Fig. 1 Medial view of the forearm and hand. 01–tendon of the flexor carpi ulnaris muscle; 02–dorsal branch of the ulnar nerve; 03–medial division of the dorsal branch of the ulnar nerve, the filled arrow indicates the dissected segment and the interrupted arrow indicates the path associated to the pisiform bone and with fibromuscular tissue overlay; 04–intermediary division of the dorsal branch of the ulnar nerve; 05–lateral division of the dorsal branch of the ulnar nerve; 06–pisiform bone; 07–abductor digiti minimi muscle; A–anterior, and D–distal.

Fig. 2 Volar view with slight displacement of the nerve structures as from the metal spatula. 03–completely dissected medial division of the dorsal branch of the ulnar nerve (double filled arrow) and in anastomosis at the midpoint between the ulnar nerve (08), the deep branch of the ulnar nerve (09) and the superficial branch of the ulnar nerve (the Kaplan anastomosis variant); 06–pisiform bone; 07–abductor digiti minimi muscle; 10–common palmar digital nerve; 11–proper palmar digital nerve; 12–motor branch for the palmaris brevis muscle; and 13–deep face of the palmaris brevis muscle, partially retracted from its origin or distal insertion M–medial and D–distal.

Fig. 3 Sulcus in the pisiform bone (6) represented by the discontinuous black line in the sulcus and in the medial and anterior aspect of this bone; 03–Kaplan-type anastomosis (double filled arrow); 08–ulnar nerve; 13–deep face of the palmaris brevis muscle, partially retracted from its origin or proximal insertion; 14–deep branch of the ulnar artery; asterisk (*) – surgical instrument pulling the ulnar artery as from its adventitia; M – medial, and D – distal.

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Unusual Anastomosis between Branches of the Ulnar Nerve (Kaplan Type Anastomotic Variant) – Case Report

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[1] Address for correspondence Kennedy Martinez de Oliveira, M.D., Anatomy and Image Department, Federal University of Minas Gerais-UFMG, Av. Professor Alfredo Balena, 190, Zip Code 30130-100, Belo Horizonte/MG, Brazil (e-mail: kennedy.martinez@gmail.com).