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Bordas C, Piessat C, Perez M, Gondim Teixeira PA, Dap F, Athlani L. Reconstruction of the ulnar artery in Guyon's canal with an arterial graft: Anatomical study. HAND SURGERY & REHABILITATION 2024; 43:101617. [PMID: 37951495 DOI: 10.1016/j.hansur.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
Ulnar artery thrombosis in Guyon's canal can lead to vascular insufficiency in the fingers. The recommended treatment is resection and reconstruction of the pathological area. A bypass may be necessary, which may be venous or arterial. Arterial bypasses have better long-term patency; however, they are a source of donor-site complications. We carried out an anatomical study on 11 upper limbs and 7 lower limbs from cadavers to identify a technically accessible arterial graft, of a diameter suitable for bypassing the ulnar artery in Guyon's canal and with acceptable scar sequelae (few predicted postoperative complications, discreet size and/or location of scar). Three grafts were considered: anterior interosseous artery, radial recurrent artery and descending genicular artery. The various grafts were dissected and harvested from cadaver specimens, then their lengths and diameters were measured. The diameter of the candidate grafts was compared to the diameter of the distal ulnar artery. The diameter of the descending genicular artery matched the ulnar artery better than the radial recurrent artery or the anterior interosseous artery (103% vs 44% and 67%, respectively). Mean graft length was 6.6 cm. The anatomical configuration of the descending genicular artery allowed Y-shaped bypasses to be performed. Harvesting this artery appears to cause little damage and allows bypasses up to 6 cm to be performed. Despite its smaller diameter making it necessary to perform a microvascular size adjustment, the anterior interosseous artery is a candidate graft because it is long enough (119 mm) and located near the surgical site. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Coralie Bordas
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, France.
| | - Colin Piessat
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, France
| | - Manuela Perez
- Faculty of Medicine and University Hospital, Department of Anatomy, University of Lorraine, Nancy, France
| | | | - François Dap
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, France
| | - Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, France
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Piessat C, De Almeida YK, Athlani L. Hypothenar hammer syndrome: outcomes after ulnar artery reconstruction with autologous vein graft. HAND SURGERY & REHABILITATION 2023; 42:203-207. [PMID: 36893887 DOI: 10.1016/j.hansur.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/09/2023]
Abstract
The most common surgical procedure for the treatment of hypothenar hammer syndrome (HHS) is resection of the pathological segment followed by arterial reconstruction using a venous bypass. Bypass thrombosis occurs in 30% of cases, with various clinical consequences, ranging from no symptoms to reappearance of the preoperative clinical symptoms. We reviewed 19 patients with HHS who underwent bypass graft, to assess clinical outcomes and graft patency, with a minimum follow-up of 12 months. Objective and subjective clinical evaluation and ultrasound exploration of the bypass were carried out. Clinical results were compared according to bypass patency. At a mean follow-up of 7 years, 47% of patients had complete resolution of symptoms; symptoms were improved in 42% of cases, and unchanged in 11%. Mean QuickDASH and CISS scores were 20.45/100 and 28/100, respectively. Bypass patency rate was 63%. Patients with patent bypass had shorter follow-up (5.7 vs 10.4 years; p = 0.037) and a better CISS score (20.3 vs 40.6; p = 0.038). There were no significant differences between groups for age (48.6 and 46.7 years; p = 0.899), bypass length (6.1 and 9.9 cm; p = 0.081) or QuickDASH score (12.1 and 34.7; p = 0.084). Arterial reconstruction gave good clinical results, with the best results in case of patent bypass. Level of evidence: IV.
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Affiliation(s)
- Colin Piessat
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 Rue Hermite, 54000 Nancy, France.
| | - Yoan-Kim De Almeida
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 Rue Hermite, 54000 Nancy, France
| | - Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 Rue Hermite, 54000 Nancy, France
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3
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Titan AL, Chang J, Megerle K, Murray P, Hammert W. State of the art review: The management of chronic vascular disorders in the hand and upper limb. J Hand Surg Eur Vol 2023; 48:295-302. [PMID: 36753288 DOI: 10.1177/17531934221145498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
This review article summarizes the basic principles of vascular anatomy, physiology, diagnostic work-up and treatment for patients with nontraumatic upper extremity vascular disorders. Vascular disorders can be considered vasospastic or occlusive. The most commonly encountered vasospastic condition is Raynaud's Phenomenon secondary to scleroderma. While historically this has been managed medically with vasodilators, more advanced cases can benefit from surgical treatment to improve blood flow and minimize tissue loss, with compelling evidence that earlier surgical intervention can modify disease process and should be considered. Occlusive disease can present as aneurysm or thrombosis and often requires surgical treatment with resection of the occluded segment with or without vascular reconstruction. In advanced atherosclerotic disease or end stage ischemia, arterialization of the venous system can be considered to avoid more proximal amputations.
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Affiliation(s)
- Ashley L Titan
- Department of Surgery, Division of Plastic Surgery, Stanford University Hospital, Stanford, CA, USA
| | - James Chang
- Department of Surgery, Division of Plastic Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Kai Megerle
- Centre for Hand Surgery, Microsurgery and Plastic Surgery, Schön Clinic, Munich, Germany
| | - Peter Murray
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville Florida, USA
| | - Warren Hammert
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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Bernstein DN, Cliburn JA, Lachant DJ, White RJ, Hammert WC. Evaluation of Clinical Recovery After Surgical Treatment for Hand Ischemia From Vasospastic and Occlusive Disease Using PROMIS. Hand (N Y) 2023; 18:15-21. [PMID: 33789521 PMCID: PMC9806527 DOI: 10.1177/1558944721999727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is a paucity of literature describing the recovery trajectory after surgery for upper extremity ischemia. Using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Upper Extremity (UE), Pain Interference (PI), and Depression domains, we aimed to describe the postoperative recovery of such patients. METHODS We queried our PROMIS database for patients undergoing surgery for vasospastic or occlusive disease over a 4.5-year period. Inclusion criteria were preoperative, early (average 3 weeks) and late (average 6 months) postoperative PROMIS PF and/or UE, PI, and Depression scores. The change in PROMIS scores was calculated for each time point. Changes in PROMIS scores were compared with minimal clinically important difference estimates. RESULTS We identified 13 patients undergoing 13 surgical interventions that met inclusion criteria. More than one-half of our patients were men (n = 7 [54%]), and more than one-half of the surgeries (n = 7 [54%]) were for isolated occlusive diagnoses, with the remainder for vasospastic disease. At short-term postoperative follow-up, the change in PROMIS PF, UE, PI, and Depression scores was -6.34 (SD: 9.13), -6.81 (SD: 9.61), 3.16 (SD: 5.78), and -3.05 (SD: 8.37), respectively. At mid-term postoperative follow-up, the change in PROMIS PF, UE, PI, and Depression scores was 4.45 (SD: 10.33), 8.04 (SD: 13.84), -7.03 (SD: 7.06), and -12.27 (SD: 10.85), respectively. CONCLUSIONS Our findings suggest patients undergoing surgical treatment for upper extremity ischemia experience a worsening of functional symptoms initially, as expected, followed by notable improvement.
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Bilateral Hypothenar Hammer Syndrome Case Presentation and Literature Review. Case Rep Vasc Med 2022; 2022:2078772. [PMID: 35800397 PMCID: PMC9256417 DOI: 10.1155/2022/2078772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/27/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022] Open
Abstract
Hypothenar hammer syndrome is a rare cause of vascular insufficiency. Generally, patients report a history of repetitive trauma to the hypothenar region of the hand. Symptoms often consist of cold intolerance, pain, paleness, and paresthesia due to digital ischemia. The severity of these symptoms will depend on the extent of ulnar artery occlusion and the presence or absence of collaterals between this artery's superficial and deep branches. It is a rare clinical entity, which on multiple occasions requires a surgical approach. We present a 63-year-old man with bilateral Raynaud's phenomenon secondary to hypothenar hammer syndrome successfully treated by vascular repair surgery. In patients with Raynaud's phenomenon, it is important to know that there are reversible causes such as hypothenar hammer syndrome.
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Jud P, Pregartner G, Berghold A, Rief P, Muster V, Gütl K, Brodmann M, Hafner F. Endovascular Thrombolysis in Hypothenar Hammer Syndrome: A Systematic Review. Front Cardiovasc Med 2021; 8:745776. [PMID: 34977173 PMCID: PMC8714786 DOI: 10.3389/fcvm.2021.745776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: Hypothenar hammer syndrome (HHS) is a rare vascular disease caused by blunt trauma of the hypothenar region. The optimal therapeutic strategy remains debatably since no large comparative studies are available yet. We want to evaluate the effectiveness of intra-arterial thrombolysis on angiographic and clinical outcome parameters in patients with HHS by performing a systematic review of the existing literature. Methods: A literature search of PUBMED/MEDLINE and SCIENCE DIRECT databases was performed up to May 2021. Results: In total, 16 manuscripts with 43 patients were included in the systematic review. Intra-arterial thrombolysis led to angiographic improvement in 29 patients (67.4%) and to clinical improvement in 34 patients (79.1%). Deterioration of arterial perfusion or clinical symptoms after thrombolysis were absent. Post-interventional complications were reported in only one patient (2.3%) without any bleeding complication. Logistic regression analyses demonstrated that a combined administration of fibrinolytics and heparin was associated with a significantly improved arterial patency [OR 12.57 (95% CI 2.48–97.8), p = 0.005] without significant amelioration of clinical symptoms [OR 3.20 (95% CI 0.6–18.9), p = 0.172]. The use of rt-PA compared to other fibrinolytics and a prolonged thrombolysis duration of more than 24 h did not show statistically significant effects. Intra-arterial thrombolysis was significantly less effective in patients who had undergone thrombolysis with a delay of more than 30 days regarding clinical improvement [OR 0.07 (95% CI 0.00–0.54), p = 0.024]. Conclusions: Intra-arterial thrombolysis with a combination of fibrinolytics and heparin is an effective and safe therapeutic option in patients with acute HHS.
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Affiliation(s)
- Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- *Correspondence: Philipp Jud
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Peter Rief
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Viktoria Muster
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Katharina Gütl
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Hart J, Hajjar R, Laveroni E. Hypothenar hammer syndrome and repair of ulnar artery aneurysm in a patient without history of trauma. BMJ Case Rep 2021; 14:14/5/e240729. [PMID: 34016629 DOI: 10.1136/bcr-2020-240729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The patient is a 50-year-old male with a history of tobacco use presented for evaluation of pulsatile right-hand mass. The patient was employed as a barber but had no known history of trauma or injury. He was diagnosed with hypothenar hammer syndrome and underwent excision of ulnar artery aneurysm with reconstruction of ulnar artery with interposition saphenous vein graft. The presented case describes an uncommon presentation of hypothenar hammer syndrome in a patient without history of repetitive blunt trauma or injury and discusses the diagnosis, pathophysiology and treatment options for symptomatic ulnar artery aneurysm.
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Affiliation(s)
- Justin Hart
- Plastic and Reconstructive Surgery, Beaumont Hospital - Farmington Hills, Farmington Hills, Michigan, USA
| | - Raymond Hajjar
- Plastic and Reconstructive Surgery, Beaumont Hospital - Farmington Hills, Farmington Hills, Michigan, USA
| | - Eugene Laveroni
- Vascular Surgery, Beaumont Hospital - Farmington Hills, Farmington Hills, Michigan, USA
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Odajima R, Nishimoto S, Kawai K, Ishise H, Kakibuchi M. A traumatic ulnar artery aneurysm in an infant. J Surg Case Rep 2021; 2021:rjab098. [PMID: 33884166 PMCID: PMC8046017 DOI: 10.1093/jscr/rjab098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
Ulnar artery aneurysm is very rare in infancy. Only a few reports have been done. We report an 8-month-old baby with true ulnar artery aneurysm on her hypothenar eminence. She had no specific past medical history, but an episode of falling. We resected the pulsating mass compressing the ulnar nerve, utilizing a surgical microscope. Reconstruction of the vascular deficit was not performed. She presented no functional deficit of the hand and no evidence of growth disturbance so far. As hypothenar eminence is a susceptible part for repetitive strikes, and as vein is fragile to the pressure, bypassing arterial route with vein graft is not recommended unless there is no other option.
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Affiliation(s)
- Rika Odajima
- Department of Plastic Surgery, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
| | - Soh Nishimoto
- Department of Plastic Surgery, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
| | - Kenichiro Kawai
- Department of Plastic Surgery, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
| | - Hisako Ishise
- Department of Plastic Surgery, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
| | - Masao Kakibuchi
- Department of Plastic Surgery, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
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9
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Diaz-Abele J, Saganski E, Islur A. Use of Arterial Grafts in Hypothenar Hammer Syndrome: Application of Perforator Flap Anatomy. Plast Surg (Oakv) 2020; 28:204-209. [PMID: 33215034 DOI: 10.1177/2292550320933684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Hypothenar hammer syndrome (HHS) is traditionally treated with venous bypass grafting, but controversy has arisen as arterial grafts have become more available. Methods A retrospective review of all patients undergoing ulnar artery bypass grafting for HHS with an arterial graft from 2008 to 2017 was performed. We also review the literature for patency rates and discuss the scenarios that favor different graft choices. Results Six patients were included in our series. Five had primary surgery and 1 had revision surgery for HHS. Five arterial grafts were from the deep inferior epigastric artery and 1 was from the lateral circumflex femoral artery. The proximal anastomotic site was the ulnar artery for all: n = 6. The distal anastomosis site was the palmar arch and common digital artery (CDA) of the ring/small finger and CDA of the middle/ring finger: n = 3; the palmar arch and the CDA of the ring/small finger: n = 3. All patients were symptom-free at follow-up and had a patent ulnar artery on Allen's testing or angiogram. Conclusion Patency rates of arterial grafts for HHS appear to be excellent and this small series and may offer an alternative to traditional venous grafts and end-to-end arterial anastomoses. We suggest using arterial perforator grafts from free flap donor sites. These have well-described anatomy, are easily harvested, and carry minimal donor site morbidity. Lateral circumflex femoral artery graft is favored in patients requiring a single distal anastomosis, who have a ventral hernia, or who are obese. Deep inferior epigastric artery graft is preferred when multiple distal targets or versatile configurations are needed, in thin patients, or in female patients.
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Affiliation(s)
- Julian Diaz-Abele
- Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Emily Saganski
- Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Avinash Islur
- Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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10
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Malsagova AT, van Burink MV, Smits ES, Zöphel OT, Stassen CM, Botman JMJ, Rakhorst HA. Prospective assessment of function and cold-intolerance following revascularization for hypothenar hammer syndrome. J Plast Reconstr Aesthet Surg 2020; 73:2164-2170. [PMID: 32565138 DOI: 10.1016/j.bjps.2020.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/31/2020] [Accepted: 05/15/2020] [Indexed: 01/24/2023]
Abstract
Ulnar artery revascularization in hypothenar hammer syndrome has repeatedly been shown to reduce ischaemic symptoms, however with varying graft patency percentages. This study prospectively assesses the effect of revascularization surgery with a vein graft using validated questionnaires in seven patients. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Cold Intolerance Symptom Severity (CISS) questionnaires have been used to compare the preoperative and postoperative functionality and cold intolerance. All patients showed improvement in either functionality, or cold intolerance, or both from disabled to nearly normalized levels and resumed their occupation at final follow-up (mean of 28 months). Strikingly this was also the case in a patient with graft stenosis. Patients with the highest preoperative questionnaire scores showed most postoperative improvement. In conclusion, revascularization surgery seems to improve the symptomatology irrespective of graft patency. Questionnaires can be a valuable contribution to quantify and to follow the symptomatology in hypothenar hammer syndrome.
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Affiliation(s)
- A T Malsagova
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands
| | - M V van Burink
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands.
| | - E S Smits
- Department of Plastic Surgery, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 Rotterdam, CE, the Netherlands
| | - O T Zöphel
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands
| | - C M Stassen
- Department of Radiology, Ziekenhuisgroep Twente in Almelo and Hengelo/Medisch Spectrum Twente, the Netherlands
| | - J M J Botman
- Department of General Surgery, Ziekenhuisgroep Twente Almelo and Hengelo, the Netherlands
| | - H A Rakhorst
- Department of Plastic Surgery, Ziekenhuisgroep Twente in Almelo and Hengelo, Zilvermeeuw 1, 7609 PP Almelo, the Netherlands, Department of Plastic Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 Enschede, KZ, the Netherlands
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Demetri L, Lans J, Gottlieb R, Dyer GSM, Eberlin KR, Chen NC. Long-term Patient-Reported Outcomes After Surgery for Hypothenar Hammer Syndrome. Hand (N Y) 2020; 15:407-413. [PMID: 30417693 PMCID: PMC7225894 DOI: 10.1177/1558944718810860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: This study aims to describe the long-term patient-reported outcomes after surgery for hypothenar hammer syndrome (HTHS) and to identify factors associated with inferior outcomes. Methods: We retrospectively identified 27 patients who underwent surgical intervention for HTHS from 2002 to 2016. Fifteen patients (56%) completed outcome questionnaires: Quick Disabilities of the Arm, Shoulder, and Hand, Cold Intolerance Symptom Severity (CISS) survey, Patient-Reported Outcomes Measurement Information System Upper Extremity Computer Adaptive Test, and Patient-Reported Outcomes Measurement Information System Pain Interference Computer Adaptive Test. The median questionnaire follow-up was 7.2 years (interquartile range, 3.1-9.9). Outcomes were compared across different surgical techniques, and the influence of patient-related factors on outcomes was also evaluated. Results: Six (40%) patients experienced complete symptom resolution, 6 (40%) had improvement without complete resolution, 1 (7%) had resolution followed by recurrence, and 2 (13%) reported no improvement. The most common symptom after surgical intervention was cold intolerance. Questionnaire scores were similar across ligation, direct repair, and vein graft vascular reconstruction. Patients had better CISS scores if they had surgery on their nondominant hand (13.2 vs 38.6) and did not have a manual labor job (18.1 vs 40.5). Conclusions: Surgery for HTHS leads to moderate long-term improvement in patient-reported outcomes. Different surgical techniques yield similar symptomatic relief. Manual labor and surgery of the dominant hand are associated with worse CISS scores.
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Affiliation(s)
- Leah Demetri
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA
| | - Jonathan Lans
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA
| | - Rachel Gottlieb
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA
| | - George S. M. Dyer
- Harvard Medical School, Boston, MA, USA,Brigham and Women’s Hospital, Boston, MA, USA
| | - Kyle R. Eberlin
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA
| | - Neal C. Chen
- Massachusetts General Hospital, Boston, USA,Harvard Medical School, Boston, MA, USA,Neal C. Chen, Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
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St-Pierre F, Shepherd RF, Bartlett MA. Diagnosis of hypothenar hammer syndrome in a patient with acute ulnar artery occlusion. BMJ Case Rep 2019; 12:12/9/e230963. [PMID: 31519720 DOI: 10.1136/bcr-2019-230963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 56-year-old truck driver with a history of tobacco use presented with acute onset digital ischaemia in the ulnar distribution of his dominant hand, associated with severe pain. Occupational exposures included extensive manual labour and prolonged vibratory stimuli. Workup with Doppler and angiography confirmed the diagnosis of hypothenar hammer syndrome (HHS). After the failure of medical management, he underwent ulnar artery thrombectomy with reconstruction and arterial bypass grafting. His pain improved significantly postsurgically, and he was able to return to a normal routine. This case illustrates the classic presentation, examination, imaging findings and management options of HHS. HHS should be considered in patients with digital ischaemia and associated occupational exposures. Diagnosing the condition appropriately allows for optimal management, aiming at minimising symptoms and maximising quality of life.
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Affiliation(s)
| | - Roger F Shepherd
- Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Carr MP, Becker GW, Taljanovic MS, McCurdy WE. Hypothenar hammer syndrome: Case report and literature review. Radiol Case Rep 2019; 14:868-871. [PMID: 31193096 PMCID: PMC6517613 DOI: 10.1016/j.radcr.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/16/2019] [Accepted: 04/20/2019] [Indexed: 12/02/2022] Open
Abstract
Hypothenar hammer syndrome is a rare but serious cause of digital ischemia and morbidity. Presented here is a case of a manual laborer who had symptoms of digital ischemia after acute hyperextension injury to the ring finger. Magnetic resonance imaging revealed thrombosed ulnar artery aneurysm. Etiology, presentation, and current treatments are reviewed.
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Affiliation(s)
- Marcus P Carr
- Department of Medical Imaging, University of Arizona College of Medicine, Banner - University Medical Center, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ 85724, USA
| | - Giles W Becker
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Banner - University Medical Center, 1501 N. Campbell Ave., PO Box 245064, Tucson, AZ 85724, USA
| | - Mihra S Taljanovic
- Department of Medical Imaging, University of Arizona College of Medicine, Banner - University Medical Center, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ 85724, USA
| | - Wendy E McCurdy
- Department of Medical Imaging, University of Arizona College of Medicine, Banner - University Medical Center, 1501 N. Campbell Ave., P.O. Box 245067, Tucson, AZ 85724, USA
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14
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Bouvet C, Bouddabous S, Beaulieu JY. Aneurysms of the hand: Imaging and surgical technique. HAND SURGERY & REHABILITATION 2018; 37:186-190. [PMID: 29567084 DOI: 10.1016/j.hansur.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 02/17/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
Abstract
Hand aneurysms are a rare entity only described as case reports in the literature. The aim of our study was to describe a series of four cases and the surgical technique using an arterial bypass. We also wanted to define an algorithm for the imaging of this pathology. We have operated on four patients with hand aneurysms in the past decade or so. One patient had an aneurysm in the thumb proper palmar digital artery, one in the superficial palmar arch and the two others in the ulnar artery. All patients had an excision surgery with direct arterial bypass; no patient had a venous graft. All patients were seen a few years after the surgery and underwent an ultrasonography to check the anastomosis permeability. All anastomoses were permeable 2 to 8 years after surgery. Through a review of the literature we discuss the best algorithm for imaging a hand aneurysm. Direct arterial suture by proximal and distal mobilization allows for long-term permeability. If a graft is necessary, a graft of arterial origin should be preferred. The additional first-line examination is ultrasonography, followed by arteriography if acute ischemia is present; otherwise, CT angiography or MR angiography is performed.
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Affiliation(s)
- C Bouvet
- Hand surgery and peripheral nerves unit, division of orthopedics and trauma surgery, Geneva university hospital, rue Gabrielle Perret Gentil 4, 1211 Geneva, Switzerland.
| | - S Bouddabous
- Department of radiology, Geneva university hospital, rue Gabrielle Perret Gentil 4, 1211 Geneva, Switzerland
| | - J-Y Beaulieu
- Hand surgery and peripheral nerves unit, division of orthopedics and trauma surgery, Geneva university hospital, rue Gabrielle Perret Gentil 4, 1211 Geneva, Switzerland
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Jiménez I, Manguila F, Dury M. Hypothenar hammer syndrome. A case report. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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de Niet A, Van Uchelen JH. Hypothenar hammer syndrome: long-term follow-up after ulnar artery reconstruction with the lateral circumflex femoral artery. J Hand Surg Eur Vol 2017; 42:507-510. [PMID: 26686806 DOI: 10.1177/1753193415622592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED In symptomatic patients with hypothenar hammer syndrome, the occluded part of the ulnar artery can be reconstructed with an autologous graft. Venous grafts are used frequently, but they are known for their low patency rate. Arterial grafts show better patency rates than venous grafts in coronary bypass surgery. We performed 11 ulnar artery reconstructions with the descending branch of the lateral circumflex femoral artery and compared these with previously performed venous reconstructions. All patients with an arterial graft reconstruction had a patent graft at a mean follow-up of 63 months. In addition, nine out of 11 patients reported improvement in their symptoms. The patency rate of venous reconstructions in hypothenar hammer syndrome is significantly lower. Arterial grafting for hypothenar hammer syndrome has superior patency compared with venous grafting; we recommend it as the surgical treatment of choice for symptomatic hypothenar hammer syndrome. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A de Niet
- Department of Plastic, Isala Clinics Zwolle, Zwolle, The Netherlands
| | - J H Van Uchelen
- Department of Plastic, Isala Clinics Zwolle, Zwolle, The Netherlands
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17
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Jiménez I, Manguila F, Dury M. Hypothenar hammer syndrome. A case report. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 61:354-358. [PMID: 27843038 DOI: 10.1016/j.recot.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/20/2016] [Accepted: 09/25/2016] [Indexed: 11/30/2022] Open
Abstract
Hypothenar hammer syndrome is an uncommon injury of the ulnar artery in its passage through Guyon's canal, and has been associated with repetitive trauma. Its diagnosis requires of a high level of suspicion and a careful clinical interview. The appropriate treatment is not well defined in the literature, ranging widely from medical treatment to reconstructive surgery. A clinical case is presented of a 52 year-old healthy male, who presented with numbness of his fourth and fifth fingers after a trauma at the hypothenar eminence. The Allen test highlighted an absence of vascularisation from the ulnar artery, thus suspecting an ulnar artery thrombosis, which was later confirmed by angio-MRI. The thrombosed segment was resected and a by-pass with a forearm vein was performed to reconstruct the distal arterial flow, presenting with a good functional outcome at 6months follow-up.
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Affiliation(s)
- I Jiménez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - F Manguila
- SOS Main Strasbourg Centre, Clinique des Diaconesses. Estrasburgo, Francia
| | - M Dury
- SOS Main Strasbourg Centre, Clinique des Diaconesses. Estrasburgo, Francia
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