Saved by the SPY

Ulnar Artery Reconstruction With LCFA Graft for Hypothenar Hammer Syndrome

Zachary S. Gala, BSE; Haripriya Ayyala, MD; Stephen L. Viviano, MD; Ashley Ignatiuk, MD, MSc, FRCSC


ePlasty. 2020;20(e10) 

In This Article


A 62-year-old male carpenter with a long history of pain, pallor, discoloration, and skin lesions along the right fourth and fifth fingers was diagnosed with hypothenar hammer syndrome. MRA revealed a 2- to 3-cm segmental occlusion in the distal ulnar artery by Guyon's canal and an incomplete superficial arch. After failed treatment, the authors planned for resection of the pathologic segment, repair with an LCFA graft, and sympathetctomy. Intraoperative ICG imaging revealed an additional area of stenosed artery, previously unseen on the MRA scan. This newfound pathologic segment of artery called for a more extensive dissection, sympathectomy, arterial ligation and excision, and ultimately a larger LCFA graft. Although the resultant procedure was more drastic than previously planned, it was also more adequate for this patient's pathology. Without the intraoperative ICG imaging, no additional area of stenosis would have been seen, and the surgical management would likely have only been partially adequate. Microsurgical anastomosis was performed and postoperative ICG imaging revealed patent vessels.