Ulnar Artery Pseudoaneurysm Following Penetrating Palm Injury: A Case Report

Ulnar Artery Pseudoaneurysm Following Penetrating Palm Injury: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ulnar Artery Pseudoaneurysm Following Penetrating Palm Injury: A Case Report Halah Alhwsawi, Ian Maxwell This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8080719/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Ulnar artery pseudoaneurysms (UAPs) are rare vascular injuries resulting from trauma, surgery, or repetitive stress, potentially leading to ischemia, embolization, or nerve compression. Early recognition and appropriate management are crucial to prevent complications. This report presents a 17-year-old male who sustained a penetrating glass injury to the left palm, resulting in ulnar artery laceration. After initial ligation, he developed a progressively enlarging, bleeding palm mass. Examination revealed a 4 cm pseudoaneurysm with intact nerve and tendon function. Imaging confirmed a pseudoaneurysm from the transected ulnar artery. Surgical intervention included pseudoaneurysm excision, neurolysis, and vein graft reconstruction using a reversed 4 cm vein graft. The patient recovered fully with preserved hand function. Traumatic UAPs can present with delayed complications, requiring careful evaluation. While ligation is sometimes sufficient, vein grafting is preferred for restoring arterial continuity and preventing ischemic complications. This case highlights the importance of early diagnosis and timely surgical intervention. Vein graft reconstruction remains a reliable approach for preserving hand function, and a multidisciplinary strategy ensures optimal patient outcomes. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Ulnar artery pseudoaneurysms are rare vascular lesions that typically arise from trauma, surgical interventions, or repetitive mechanical stress. Although uncommon, they can lead to significant complications, including ischemia, embolization, or nerve compression, which may compromise hand function [ 1 – 2 ]. Early recognition and appropriate management are crucial to prevent long-term morbidity. This report presents a unique case of an ulnar artery pseudoaneurysm and laceration following a penetrating glass injury, highlighting the therapeutic approach undertaken to ensure optimal patient outcomes. Case Presentation A 17-year-old healthy male sustained a workplace injury in late August while washing a wine glass. The glass stem penetrated his left palm, resulting in significant arterial bleeding. He presented to the Emergency Department (ED) with spurting arterial bleeding suggestive of an ulnar artery laceration. Attempts to close the wound in the ED were complicated by a suture needle becoming lodged inside the wound, prompting consultation with plastic surgery. The initial surgical details are unclear, but the patient reported ulnar artery ligation. Over the following weeks, he developed a progressively enlarging palm mass that frequently bled. Physical examination revealed a 4 cm pseudoaneurysm protruding through the palm skin, with intact ulnar and median nerve function and preserved tendon integrity (Fig. 1 ). Capillary refill was less than 2 seconds, and circulation remained unimpaired. CT imaging confirmed a pseudoaneurysm originating from the transected ulnar artery (Fig. 2 ).Also Hand CT angiography was obtained (Fig. 3 ). After discussing treatment options, including ulnar artery ligation, we recommended vein graft reconstruction to restore circulation and prevent cold intolerance. Surgical Procedure: Under general anesthesia, the left hand was prepped and draped, and a tourniquet was applied. An incision was made around the pseudoaneurysm, which was excised, leaving a 3–4 cm skin defect. Further dissection exposed the cut ends of the ulnar artery. The incision was extended proximally and distally to release Guyon’s canal and ensure ulnar nerve integrity (Fig. 4 ). Neurolysis of the ulnar and median nerves confirmed no injury. Flexor tenosynovectomy of the long and ring finger flexor digitorum superficialis tendons was performed to remove scar tissue. A 4 cm vein graft was harvested from the distal forearm, reversed, and microsurgically interposed to bridge the arterial defect. Good flow was observed post-anastomosis. Multiple skin flaps were mobilized and inset to close the defect. The patient recovered uneventfully, with no signs of ischemia or graft compromise. He was discharged with a protective splint. After two weeks, he came for a follow-up for wound assessment and physical therapy. On exam, he had a complete return of hand function with no signs of complications. Discussion Ulnar artery pseudoaneurysms (UAPs) are uncommon vascular injuries, typically resulting from penetrating trauma to the hand. Early recognition and appropriate management are crucial to prevent complications such as ischemia, neuropathy, and potential loss of hand function. Traumatic pseudoaneurysms occur when a disruption in the arterial wall leads to a contained hematoma that communicates with the arterial lumen. In the upper extremity, UAPs are rare, comprising about 1% of all pseudoaneurysms [ 3 ]. Patients may present with a palpable mass, pulsatile swelling, pain, or neurological symptoms due to nerve compression [ 4 ]. In this case, the patient developed a progressively enlarging mass in the palm weeks after the initial injury, consistent with the delayed presentation often seen in UAPs. A delayed diagnosis can lead to significant complications such as nerve compression, thrombosis, and ischemia [ 4 ]. In the present case, the absence of nerve or tendon injury highlights the benefit of timely surgical intervention and thorough neurovascular evaluation, akin to outcomes reported in similar trauma cases [ 5 ]. The primary goals in treating UAPs are to exclude the pseudoaneurysm from the circulation, restore arterial continuity, and preserve hand function. Various surgical options include ligation, primary repair, or interposition grafting. While ligation may suffice in certain cases, especially when collateral circulation is adequate, it carries the risk of ischemic complications and cold intolerance [ 6 ]. Vein graft interposition is often preferred for reconstructing segmental arterial defects, as it maintains arterial continuity and reduces the risk of ischemia. In this case, a 4 cm segmental defect in the ulnar artery was successfully repaired using a reversed vein graft harvested from the distal forearm. This approach aligns with the hybrid techniques reported in the literature, where stenting or grafting was employed to maintain arterial perfusion [ 6 ]. In young, active patients, restoration of ulnar artery flow is essential to prevent functional impairment and ensure long-term outcomes. A case report described the endovascular treatment of post-traumatic pseudoaneurysms of the ulnar and radial arteries, highlighting the viability of less invasive approaches in select cases [ 3 ].However, in the context of this patient's active bleeding and the pseudoaneurysm's size, open surgical repair with vein grafting was deemed more appropriate. Conclusion This case highlights the importance of early diagnosis and appropriate surgical intervention in managing ulnar artery pseudoaneurysms resulting from trauma. Vein graft reconstruction remains a reliable method for restoring arterial continuity and preserving hand function. A multidisciplinary approach involving both vascular and plastic surgeons is essential for optimal outcomes in complex hand injuries. Declarations Funding: None. Consent to Publish declaration: A written informed consent for publication was obtained from the legal guardian. Ethics Statement: Not applicable. Clinical Trial Registration: Not applicable. Conflicts of Interest: The authors declare that they have no conflicts of interest. Data Availability: Not applicable. Author Contributions: All authors contributed to the writing, editing, and final approval of the manuscript. References Kalyanaraman E, Rathlawath S. Ulnar artery pseudoaneurysm following penetrating injury: A case report. Indian J Appl Res. 2017;7. Ryu S, Kim I. Pseudoaneurysm of ulnar artery after endoscopic carpal tunnel release. J Korean Neurosurg Soc. 2010;48(4):380-382. doi:10.3340/jkns.2010.48.4.380 Khatri S, Epstein S, Kashfi S. Peripheral stent-graft for the management of an ulnar artery pseudoaneurysm. J Clin Imaging Sci. 2023;13:27. doi:10.25259/JCIS_80_2023 Martins RS, Gill AA, Maqbool B. Delayed formation of traumatic ulnar artery pseudoaneurysm presenting with ulnar nerve palsy: A case report. Cureus. 2022;14(9):e28744. doi:10.7759/cureus.28744 Forte A, Yeager T, Boczar D, et al. Pediatric ulnar artery pseudoaneurysm of the wrist after glass laceration: A case report and systematic review of the literature. Microsurgery. 2020;41:84-94. doi:10.1002/micr.30676 Moriarty HK, Charalabidis P, Musicki K, Phan T, Joseph T, Clements W. Hybrid management of an ulnar artery pseudoaneurysm postphlebotomy. Journal of Clinical Interventional Radiology ISVIR . 2019;03(03):185-188. doi:10.1055/s-0039-3401306 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8080719","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":574054372,"identity":"6d35b781-15c6-489c-8352-10644b72b1ab","order_by":0,"name":"Halah Alhwsawi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYBACgwPMDcwMDBYJYF5CBZBgZm4goIURpEUCquUMSAsjKVoY28AkAS3HDzZ+LqiRyDM4f/iZxMN5tdH87UAtPyq24dRifyaxWXrGMYligxtpZhKJ247nzjjM2MDYc+Y2HoclNkjzsAEV32Awu5G47VhuA1ALM2MbHi3nHzb/5vkH1HL++LcbiXOO5c4nqOVGYps0bxtQy4EcoC0NNbkbCGt52GbN2yeRuP9GTvmPhGMHcjcCtRzE65fzyYdv83yzSZzZf3yz4Y+autx55w8ffPCjArcWdHAYTB4gWj0Q1JGieBSMglEwCkYIAACyKWd1DvY+YwAAAABJRU5ErkJggg==","orcid":"","institution":"King Saud bin Abdulaziz University for Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Halah","middleName":"","lastName":"Alhwsawi","suffix":""},{"id":574054373,"identity":"30df391e-070a-4034-bdcb-65de6626f208","order_by":1,"name":"Ian Maxwell","email":"","orcid":"","institution":"Dalhousie University","correspondingAuthor":false,"prefix":"","firstName":"Ian","middleName":"","lastName":"Maxwell","suffix":""}],"badges":[],"createdAt":"2025-11-10 22:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8080719/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8080719/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100437209,"identity":"9529a028-4f4d-4a9e-bc5c-4081677074f8","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"jpg","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1681526,"visible":true,"origin":"","legend":"","description":"","filename":"Beforesurgery.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/599921cac125cca9c76a9fc8.jpg"},{"id":100437215,"identity":"38924724-a7a7-4354-bcf7-716a8b168e65","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2228418,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptofUAPanonymouscopyedited1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/fefd9cdf194d28cb1b786d57.docx"},{"id":100546963,"identity":"cd36aef2-a945-4921-ab54-32caa0c8e5ed","added_by":"auto","created_at":"2026-01-19 08:13:33","extension":"png","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":175014,"visible":true,"origin":"","legend":"","description":"","filename":"CT2.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/6e081ffadcc7b3ebe5caa4e4.png"},{"id":100547415,"identity":"3d13600b-9128-445c-8979-55f5b9b8facd","added_by":"auto","created_at":"2026-01-19 08:15:28","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":304412,"visible":true,"origin":"","legend":"","description":"","filename":"CT.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/aa957b464de25a8bfd366415.png"},{"id":100546501,"identity":"53925b45-1c56-46c4-a1a8-47ebaa6aed8c","added_by":"auto","created_at":"2026-01-19 08:09:57","extension":"jpg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2443147,"visible":true,"origin":"","legend":"","description":"","filename":"Duringsurgery.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/8336c82764f7a6ec60c8537b.jpg"},{"id":100546400,"identity":"7f3bcab0-bcc2-47e9-8f90-9af460d8f055","added_by":"auto","created_at":"2026-01-19 08:08:11","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":751744,"visible":true,"origin":"","legend":"","description":"","filename":"Hand3DCTA.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/56912e751304379c8df89b96.png"},{"id":100437214,"identity":"413e73ef-66ba-4983-a6e2-b27f515233b8","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"json","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3839,"visible":true,"origin":"","legend":"","description":"","filename":"588525f2e1e946a2be523989e8c23962.json","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/eb6b98f32452d1c0465c4215.json"},{"id":100437219,"identity":"23d7eede-2a0f-4cad-b4c3-dea9601ba7cc","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":24989,"visible":true,"origin":"","legend":"","description":"","filename":"588525f2e1e946a2be523989e8c239621enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/6f718669da3d473e90df9dec.xml"},{"id":100547509,"identity":"374318cd-e948-4c2c-b406-19875e665ba0","added_by":"auto","created_at":"2026-01-19 08:15:52","extension":"jpg","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1681526,"visible":true,"origin":"","legend":"","description":"","filename":"Beforesurgery.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/17535859fb77a6cfe64a0f55.jpg"},{"id":100437223,"identity":"05d7ccd2-60eb-4b71-b764-6f0935a546c9","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":175014,"visible":true,"origin":"","legend":"","description":"","filename":"CT2.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/2946a4f3b6eae11fa0d1c0a9.png"},{"id":100546794,"identity":"b5a61dc1-3b43-4f10-b081-f0233a405be4","added_by":"auto","created_at":"2026-01-19 08:12:37","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":304412,"visible":true,"origin":"","legend":"","description":"","filename":"CT.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/96c28c030ddbfd8fb51a441f.png"},{"id":100546728,"identity":"1ca8afcc-c1a6-4218-b800-85ab92c3d518","added_by":"auto","created_at":"2026-01-19 08:12:13","extension":"jpg","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2443147,"visible":true,"origin":"","legend":"","description":"","filename":"Duringsurgery.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/2cd51dfb83f87455dde7ec29.jpg"},{"id":100546799,"identity":"f3362e03-4325-4b20-aa81-ddc323d4314a","added_by":"auto","created_at":"2026-01-19 08:12:38","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":751744,"visible":true,"origin":"","legend":"","description":"","filename":"Hand3DCTA.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/3cb55cc80c885d261de9fab9.png"},{"id":100547541,"identity":"36e477f7-053b-4c2a-b08e-3eafb7597302","added_by":"auto","created_at":"2026-01-19 08:15:57","extension":"jpeg","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":966961,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/72cb7c3bb502bff9d2fb10b6.jpeg"},{"id":100547397,"identity":"e98a73c0-3d63-4a44-90e6-a1203f819aa4","added_by":"auto","created_at":"2026-01-19 08:15:25","extension":"jpeg","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":368215,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/4ff0d0262d72fa9236d81969.jpeg"},{"id":100437232,"identity":"ba4158a8-1d61-49ca-b16f-70e362c33d15","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"jpeg","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":422655,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/1ff2c9fcb2116245d3d2f0e8.jpeg"},{"id":100547338,"identity":"9e921f16-0182-4a3a-8916-1f7109d5de28","added_by":"auto","created_at":"2026-01-19 08:15:19","extension":"jpeg","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":439101,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/9b0d583b5d118e2bced7a051.jpeg"},{"id":100546746,"identity":"fb0d9396-e5f1-4970-8f39-229a9f2d0961","added_by":"auto","created_at":"2026-01-19 08:12:15","extension":"png","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1186712,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineBeforesurgery.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/c75ae1c335cc221e18b2fde4.png"},{"id":100437217,"identity":"d430517e-07d8-41e4-8422-7285eea07dbc","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"png","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":121644,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineCT2.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/6b99a42b5e4765415fccbce2.png"},{"id":100547158,"identity":"2806f86c-7fe0-43f7-b7bf-ba9853ec8ca2","added_by":"auto","created_at":"2026-01-19 08:14:42","extension":"png","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":47116,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineCT.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/395d74302406aba534eb9233.png"},{"id":100547418,"identity":"757eb598-fa87-4c9a-a031-a2e9d8a0ad95","added_by":"auto","created_at":"2026-01-19 08:15:28","extension":"png","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1502638,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineDuringsurgery.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/be9cdc7592d694bd966e7307.png"},{"id":100437227,"identity":"ac5219b9-1f09-4551-a5d2-685b9293cbf2","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"png","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84722,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineHand3DCTA.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/483b40b1fdd7b2202f411ed7.png"},{"id":100547198,"identity":"6979bf30-f5f7-4ef6-a6a6-f6ced3a6ae3f","added_by":"auto","created_at":"2026-01-19 08:14:52","extension":"png","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":314831,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/bd8f56453436e5ffbcff12d5.png"},{"id":100547027,"identity":"94d8e1da-905c-46d1-b406-63715d09b51c","added_by":"auto","created_at":"2026-01-19 08:14:04","extension":"png","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":109931,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/1d34581c6132641e7a34b947.png"},{"id":100437235,"identity":"6008c3f5-6b15-4dcf-a513-a20a6fdcb602","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"png","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":146573,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/f04e2ce42ae91458cd4a4749.png"},{"id":100547505,"identity":"d4644719-c356-49cf-9a25-d2d28f23a7b8","added_by":"auto","created_at":"2026-01-19 08:15:51","extension":"png","order_by":25,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":361539,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/105a5e15340a7e804e71de92.png"},{"id":100546398,"identity":"b4e5dbc3-dae9-4112-9643-2c27e60192c9","added_by":"auto","created_at":"2026-01-19 08:08:04","extension":"xml","order_by":26,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":23857,"visible":true,"origin":"","legend":"","description":"","filename":"588525f2e1e946a2be523989e8c239621structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/582b75f69536c38fd7b1dae7.xml"},{"id":100437236,"identity":"0f16e477-5cea-4d62-9a1c-77a9f617733e","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"html","order_by":27,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":29473,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/ac420b3ebe6b1c0c75d2edaa.html"},{"id":100437206,"identity":"11ba2cbe-eee6-48a1-a273-8ddbd018deb4","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":391081,"visible":true,"origin":"","legend":"\u003cp\u003eA photo showing a left hand 4 cm pseudoaneurysm protruding through the palm skin.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/95439b8d525ec2cff3059961.png"},{"id":100547148,"identity":"21a645bb-24d6-4aea-a759-4e6dc6362ddf","added_by":"auto","created_at":"2026-01-19 08:14:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":90178,"visible":true,"origin":"","legend":"\u003cp\u003eA left hand CT showing pseudoaneurysm originating from the transected ulnar artery.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/54b20d74920833cf85c2916a.png"},{"id":100547117,"identity":"6650f92b-75e3-4c1d-ab79-8c1bd07325bb","added_by":"auto","created_at":"2026-01-19 08:14:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":134364,"visible":true,"origin":"","legend":"\u003cp\u003eA left hand CT Angiography showing pseudoaneurysm originating from ulnar artery\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/70cd2b2276b4ede8eba0b373.png"},{"id":100437212,"identity":"b7e5920a-1562-4674-a402-9fa8356273de","added_by":"auto","created_at":"2026-01-16 15:51:25","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":303531,"visible":true,"origin":"","legend":"\u003cp\u003eA photo intraoperative view of an open surgical field on the palm of the hand, with clear exposure of underlying structures.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/f4e3adb4f4e5ccfb37adbf25.png"},{"id":108355479,"identity":"9f6913d3-2d09-443a-9152-ad3e1223538c","added_by":"auto","created_at":"2026-05-03 13:10:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1311025,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8080719/v1/d662f817-15ce-4589-bcf5-e0674a439826.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eUlnar Artery Pseudoaneurysm Following Penetrating Palm Injury: A Case Report\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUlnar artery pseudoaneurysms are rare vascular lesions that typically arise from trauma, surgical interventions, or repetitive mechanical stress. Although uncommon, they can lead to significant complications, including ischemia, embolization, or nerve compression, which may compromise hand function [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly recognition and appropriate management are crucial to prevent long-term morbidity.\u003c/p\u003e \u003cp\u003eThis report presents a unique case of an ulnar artery pseudoaneurysm and laceration following a penetrating glass injury, highlighting the therapeutic approach undertaken to ensure optimal patient outcomes.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 17-year-old healthy male sustained a workplace injury in late August while washing a wine glass. The glass stem penetrated his left palm, resulting in significant arterial bleeding. He presented to the Emergency Department (ED) with spurting arterial bleeding suggestive of an ulnar artery laceration. Attempts to close the wound in the ED were complicated by a suture needle becoming lodged inside the wound, prompting consultation with plastic surgery. The initial surgical details are unclear, but the patient reported ulnar artery ligation. Over the following weeks, he developed a progressively enlarging palm mass that frequently bled.\u003c/p\u003e \u003cp\u003ePhysical examination revealed a 4 cm pseudoaneurysm protruding through the palm skin, with intact ulnar and median nerve function and preserved tendon integrity (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Capillary refill was less than 2 seconds, and circulation remained unimpaired. CT imaging confirmed a pseudoaneurysm originating from the transected ulnar artery (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).Also Hand CT angiography was obtained (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). After discussing treatment options, including ulnar artery ligation, we recommended vein graft reconstruction to restore circulation and prevent cold intolerance.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurgical Procedure:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eUnder general anesthesia, the left hand was prepped and draped, and a tourniquet was applied. An incision was made around the pseudoaneurysm, which was excised, leaving a 3\u0026ndash;4 cm skin defect. Further dissection exposed the cut ends of the ulnar artery. The incision was extended proximally and distally to release Guyon\u0026rsquo;s canal and ensure ulnar nerve integrity (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNeurolysis of the ulnar and median nerves confirmed no injury. Flexor tenosynovectomy of the long and ring finger flexor digitorum superficialis tendons was performed to remove scar tissue. A 4 cm vein graft was harvested from the distal forearm, reversed, and microsurgically interposed to bridge the arterial defect. Good flow was observed post-anastomosis. Multiple skin flaps were mobilized and inset to close the defect.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe patient recovered uneventfully, with no signs of ischemia or graft compromise. He was discharged with a protective splint. After two weeks, he came for a follow-up for wound assessment and physical therapy. On exam, he had a complete return of hand function with no signs of complications.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eUlnar artery pseudoaneurysms (UAPs) are uncommon vascular injuries, typically resulting from penetrating trauma to the hand. Early recognition and appropriate management are crucial to prevent complications such as ischemia, neuropathy, and potential loss of hand function.\u003c/p\u003e \u003cp\u003eTraumatic pseudoaneurysms occur when a disruption in the arterial wall leads to a contained hematoma that communicates with the arterial lumen. In the upper extremity, UAPs are rare, comprising about 1% of all pseudoaneurysms [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients may present with a palpable mass, pulsatile swelling, pain, or neurological symptoms due to nerve compression [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In this case, the patient developed a progressively enlarging mass in the palm weeks after the initial injury, consistent with the delayed presentation often seen in UAPs.\u003c/p\u003e \u003cp\u003eA delayed diagnosis can lead to significant complications such as nerve compression, thrombosis, and ischemia [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In the present case, the absence of nerve or tendon injury highlights the benefit of timely surgical intervention and thorough neurovascular evaluation, akin to outcomes reported in similar trauma cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe primary goals in treating UAPs are to exclude the pseudoaneurysm from the circulation, restore arterial continuity, and preserve hand function. Various surgical options include ligation, primary repair, or interposition grafting. While ligation may suffice in certain cases, especially when collateral circulation is adequate, it carries the risk of ischemic complications and cold intolerance [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVein graft interposition is often preferred for reconstructing segmental arterial defects, as it maintains arterial continuity and reduces the risk of ischemia. In this case, a 4 cm segmental defect in the ulnar artery was successfully repaired using a reversed vein graft harvested from the distal forearm. This approach aligns with the hybrid techniques reported in the literature, where stenting or grafting was employed to maintain arterial perfusion [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In young, active patients, restoration of ulnar artery flow is essential to prevent functional impairment and ensure long-term outcomes.\u003c/p\u003e \u003cp\u003eA case report described the endovascular treatment of post-traumatic pseudoaneurysms of the ulnar and radial arteries, highlighting the viability of less invasive approaches in select cases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].However, in the context of this patient's active bleeding and the pseudoaneurysm's size, open surgical repair with vein grafting was deemed more appropriate.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case highlights the importance of early diagnosis and appropriate surgical intervention in managing ulnar artery pseudoaneurysms resulting from trauma. Vein graft reconstruction remains a reliable method for restoring arterial continuity and preserving hand function. A multidisciplinary approach involving both vascular and plastic surgeons is essential for optimal outcomes in complex hand injuries.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;A\u0026nbsp;\u003c/strong\u003ewritten informed consent for publication was obtained from the legal guardian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e All authors contributed to the writing, editing, and final approval of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKalyanaraman E, Rathlawath S. Ulnar artery pseudoaneurysm following penetrating injury: A case report. Indian J Appl Res. 2017;7.\u003c/li\u003e\n\u003cli\u003eRyu S, Kim I. Pseudoaneurysm of ulnar artery after endoscopic carpal tunnel release. J Korean Neurosurg Soc. 2010;48(4):380-382. doi:10.3340/jkns.2010.48.4.380\u003c/li\u003e\n\u003cli\u003eKhatri S, Epstein S, Kashfi S. Peripheral stent-graft for the management of an ulnar artery pseudoaneurysm. J Clin Imaging Sci. 2023;13:27. doi:10.25259/JCIS_80_2023\u003c/li\u003e\n\u003cli\u003eMartins RS, Gill AA, Maqbool B. Delayed formation of traumatic ulnar artery pseudoaneurysm presenting with ulnar nerve palsy: A case report. Cureus. 2022;14(9):e28744. doi:10.7759/cureus.28744\u003c/li\u003e\n\u003cli\u003eForte A, Yeager T, Boczar D, et al. Pediatric ulnar artery pseudoaneurysm of the wrist after glass laceration: A case report and systematic review of the literature. Microsurgery. 2020;41:84-94. doi:10.1002/micr.30676\u003c/li\u003e\n\u003cli\u003eMoriarty HK, Charalabidis P, Musicki K, Phan T, Joseph T, Clements W. Hybrid management of an ulnar artery pseudoaneurysm postphlebotomy. \u003cem\u003eJournal of Clinical Interventional Radiology ISVIR\u003c/em\u003e. 2019;03(03):185-188. doi:10.1055/s-0039-3401306\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8080719/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8080719/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eUlnar artery pseudoaneurysms (UAPs) are rare vascular injuries resulting from trauma, surgery, or repetitive stress, potentially leading to ischemia, embolization, or nerve compression. Early recognition and appropriate management are crucial to prevent complications.\u003c/p\u003e \u003cp\u003eThis report presents a 17-year-old male who sustained a penetrating glass injury to the left palm, resulting in ulnar artery laceration. After initial ligation, he developed a progressively enlarging, bleeding palm mass. Examination revealed a 4 cm pseudoaneurysm with intact nerve and tendon function. Imaging confirmed a pseudoaneurysm from the transected ulnar artery. Surgical intervention included pseudoaneurysm excision, neurolysis, and vein graft reconstruction using a reversed 4 cm vein graft. The patient recovered fully with preserved hand function.\u003c/p\u003e \u003cp\u003eTraumatic UAPs can present with delayed complications, requiring careful evaluation. While ligation is sometimes sufficient, vein grafting is preferred for restoring arterial continuity and preventing ischemic complications. This case highlights the importance of early diagnosis and timely surgical intervention. Vein graft reconstruction remains a reliable approach for preserving hand function, and a multidisciplinary strategy ensures optimal patient outcomes.\u003c/p\u003e","manuscriptTitle":"Ulnar Artery Pseudoaneurysm Following Penetrating Palm Injury: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 15:51:20","doi":"10.21203/rs.3.rs-8080719/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aef93e09-08b5-4775-94a9-69c7280490d2","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-03T13:09:52+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 15:51:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8080719","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8080719","identity":"rs-8080719","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}