A Communicating Branch between the Dorsal and Superficial Ramus of the Ulnar Nerve (Kaplan's Anastomosis): Clinical and Surgery Discussion

Abstract

SUMMARY:The Kaplan´s anastomosis represents the communication between the dorsal and superficial branch of the ulnar nerve distal to ulnar canal. In the present study, a case about this nerve communication, found in a male adult cadaver, is reported. Information about brachial plexus distal anastomosis is fundamental for interpretation of clinical and electrophysiological findings, in order to establish the precise diagnosis of neurological lesions at this level. Its relations with flexor carpi ulnaris muscle's tendon and with pisiform bone exposes it to iatrogenic lesions during surgery.

Anastomose incomum entre ramos do nervo ulnar (variante anastomótica de Kaplan) – Relato de caso

“…8 However, there are variations of this anastomosis such as the atypical connection of the dorsal branch to the deep branch of the ulnar nerve as described by Ghabriel and Makar. 9 In this study, the anastomosis occurred between the medial division of the dorsal branch of the ulnar nerve at a midpoint between the origins of the superficial and deep branches, a finding that differs from those of Paraskevas et al 6 and Torre et al, 7 in which both studies reported anastomosis of the dorsal branch of the ulnar nerve to the ulnar nerve proximal to the emissions of the superficial and deep branches. In addition, the anastomotic medial division did not suppress the cutaneous aspect of the medial margin of the hand in direction of the dorsal face, which differs from previous papers.…”

“…8 No entanto, existem variações desta anastomose, como a conexão atípica do ramo dorsal ao ramo profundo do nervo ulnar conforme descrito por Ghabriel e Makar. 9 Neste estudo, a anastomose ocorreu entre a divisão medial do ramo dorsal do nervo ulnar no ponto médio entre as origens dos ramos superficial e profundo, achado que difere daqueles de Paraskevas et al 6 e Torre et al, 7 uma vez que ambos estudos relataram anastomose do ramo dorsal do nervo ulnar ao nervo ulnar proximal às emissões dos ramos superficial e profundo. Além disso, a divisão medial anastomótica não suprimiu o aspecto cutâneo da margem medial da mão em direção à face dorsal, o que difere de trabalhos anteriores.…”

“…The Kaplan anastomosis constitutes a rare communication between the proper digital branch of the minimi finger (medial) and the dorsal branch of the ulnar nerve 4 5 6 7 and presents, due to its superficial location, significant clinical and surgical implications, including iatrogenic. 8 However, there are variations of this anastomosis such as the atypical connection of the dorsal branch to the deep branch of the ulnar nerve as described by Ghabriel and Makar.…”

“…A anastomose de Kaplan constitui uma comunicação incomum entre o ramo digital próprio do dedo mínimo (medial) e o ramo dorsal do nervo ulnar 4 5 6 7 e apresenta, devido à sua localização superficial, implicações clínicas e cirúrgicas significativas, inclusive iatrogênicas. 8 No entanto, existem variações desta anastomose, como a conexão atípica do ramo dorsal ao ramo profundo do nervo ulnar conforme descrito por Ghabriel e Makar.…”

Coexistence of bilateral Langer’s arm arch and Kaplan’s anastomosis: a case report and literature review

“…Kaplan's anastomosis provides sensory innervation to this region, with variations on the nervous distribution pattern. It accounts for the pain and loss of sensitivity in patients undergoing hand surgery due to damage to the pisiform bone, the flexor carpi ulnaris tendon, or damage to the Guyon canal (Torre et al, 2015).…”