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Frederik Kloss, Vincent März, Frederik Schlottmann, Peter M. Vogt. Case 13 (2024): Hypothenar hammer syndrome after minor injury to the hand. Journal of Plastic, Breast & Reconstructive Surgery. 2024.
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Frederik Kloss1, Vincent März1, Frederik Schlottmann1, Peter M. Vogt1
A 17 year old, male patient presented six weeks after a work-related, minor trauma to the left hand with an exertion related malperfusion syndrome of the fourth and fifth finger. Contemplating the clinical symptoms and initiated medical imaging the initial blunt crush injury with a drilling machine battery resulted in an aneurysmatic occlusion of the ulnary artery.
BeforeAfterA 17 year old, male patient presented six weeks after a work-related, minor trauma to the left hand with an exertion related malperfusion syndrome of the fourth and fifth finger. Contemplating the clinical symptoms and initiated medical imaging the initial blunt crush injury with a drilling machine battery resulted in an aneurysmatic occlusion of the ulnary artery.
17 year old, right handed male patient in good physical condition and professional training for a roofer. Symmetric configuration of the soft tissue with a centimeter long scar in the hypothenar region of the left hand. No muscular atophy. Fist closure, finger extension and spreading of the long fingers is powerful on both sides. The Phalen-Test is negative and there is no Hofmann-Tinel sign over the carpal canal or ulnar nerve sulcus. Isolated examination of the flexor- and extensor-tendons and a regular 2-point discrimination of 6 mm on all long fingers reveal no evidence of a sensomotoric deficit. The peripheral blood flow shows an ungual recapillarization time of
We treat a young patient with the need of utmost functionality regarding his age, physical fitness, personal aspirations and occupational requirements as a roofer. Hence, there is a need of evaluating the actual patency of the ulnar artery and considering conservative, as well as minimally invasive and open surgical methods. Providing the most accuracy we initiated an angiography also providing the therapeutic option of performing a simultaneous angioplasty, according to the extent and level of stenosis.
Preoperative Allen Test demonstrates a malperfusion of the fingers.
The pressure on the radial artery is released and the perfusion of the fingers restored.
The y-shaped Millesi approach is chosen to gain optimal exposure of the palm with the possibility of extending the preparation to the fingers. Furthermore it may be combined with the classical ulnary approach to the loge de guyon.
The ulnar artery is identified after a cutting through the fascia at the distal forearm. The flexor carpi ulnaris muscle provides as anatomic landmark as the ulnar artery is situated right medial to it. The preparation is extended to the palm and the palmar aponeurosis as well as the short palmar muscles are opened to gain access to the superficial palmar arch.
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Restore the blood flow and check for the patency of the ulnar artery.
Place vascular clips before and after the excision margins and use microscissors to obtain straight and smooth edges when excising the vessel.
Obtain a vein graft from the distal forearm and use standard microsurgery techniques to place the vein in a reversed direction as an interposition graft.
Perform sonographic examinations of the patient in regular follow-up consultations and check for patency of the vascular reconstruction in addition to clincal examinations and the reported subjective symptoms.
