Saved by the SPY: Ulnar Artery Reconstruction With LCFA Graft for Hypothenar Hammer Syndrome

Introduction: Hypothenar Hammer syndrome refers to thrombosis/aneurysm of ulnar artery at Guyon's canal in wrist, with resultant arterial insufficiency in the ulnar artery distribution.1 Patients typically describe unilateral symptoms in the fourth and/or fifth fingers of the hand. Symptoms can range from asymptomatic to pain, pallor, paresthesia, weakness, cold intolerance, and eventually ulceration, necrosis, and gangrene of the distal digits.1 Treatment options range from conservative, lifestyle management, to medication, and ultimately to surgical intervention. In this case report, we outline the second successful lateral circumflex femoral artery (LCFA) graft reconstruction of the ulnar artery in the setting of Hypothenar Hammer Syndrome conducted by the senior author. However, during this procedure, the use of intraoperative intravenous (IV) injection of indocyanine green (ICG) dye (hereafter ICG) imaging helped identify an additional area of stenosis previously unseen on pre-operative MRA, therefore enabling us to perform a more adequate resection and repair. To our knowledge, the use of intraoperative ICG for Hypothenar Hammer Syndrome and/or ulnar artery reconstruction has not been documented in the literature.