Peripheral Arterial Bypass Using Interpositional Vein Graft in the Hypothenar Hammer Syndrome

ABSTRACT

PURPOSE: The clinical syndrome of unilateral finger ischemia, caused by digital artery occlusions from embolization from the palmar ulnar artery associated with repetitive striking of the palm, has been called the hypothenar hammer syndrome(HHS). We report the case of a man with this unique disease probably caused by manual work. METHODS: A 52-year-old male left-hand dominant manual worker complained of pain and coldness in the left 4,5th finger. On physical examination, there was a tip necrosis and the result of Allen's test was mildly positive(sluggish filling of hand from the ulnar artery). Arteriograms confirmed occlusion of the distal ulnar artery without direct perfusion of the superficial palmar arch and distal digital artery. Surgical bypass with reverse autologous vein grafting was performed between ulnar artery and superficial palmar arch, common digital artery. RESULTS: He had an uneventful postoperative course and has remained asymptomatic for 18 months since discharge. Patency has been confirmed by color doppler with resolution of cold intolerance and successful digital preservation. CONCLUSION: We introduce a very unique pattern of vascular ischemic disease and recommend the arterial bypass with vein interpositional grafting.