This report describes an unusual pattern of the first dorsal metacarpal artery (FDMA) regarding its course and termination. This FDMA had an abnormal course, passing deep to various anatomical elements related to the index finger, with unusual termination in the radial and ulnar proper palmar digital arteries feeding the second and third fingers, respectively. There is no mention of this anatomical variation in the literature. We report the possible embryological origin of this case and other variations related to the FDMA. This unusual pattern represents a new reason to consider anatomical knowledge important for surgeons whose procedures are in this area and to ensure an accurate diagnosis and safe treatment of pathologies that might engage this anatomical variation.