Ulnar artery reconstruction in hypothenar hammer syndrome with heterotopic placement in carpal tunnel—A strategy for improved patency

Ulnar artery thrombosis from hypothenar trauma is an uncommon cause of digital ischaemia, most often associated with Hypothenar hammer syndrome (HHS). Standard treatment includes segmental excision and autologous vein grafting along the Guyon's canal, but this may be suboptimal in patients with occupational risk factors. We report a case where the vein graft was rerouted through the carpal tunnel to avoid subsequent compression at Guyon's canal. To our knowledge, this is the first report of this anatomical approach. The patient achieved excellent graft patency and functional recovery at 6 months, suggesting a promising surgical alternative in select cases.