Conservative Management of a Traumatic Deep Palmar Arch Pseudoaneurysm with Delayed Ulnar Motor Dysfunction: A Case Report

Traumatic pseudoaneurysms of the palmar arch are rare vascular lesions and are typically managed with surgical repair or endovascular exclusion. Deep palmar arch involvement is particularly uncommon, and neurological deficits are often considered indications for exploration. We report the case of a 26-year-old male with a penetrating palm injury resulting in a bilobulated deep palmar arch pseudoaneurysm, a thenar hematoma, and delayed ulnar motor dysfunction. Because there was no digital ischemia, ongoing bleeding, or lesion expansion, conservative management with structured clinical and radiological surveillance was selected. Serial computed tomography angiography demonstrated early interval thrombosis and vascular stability. Intrinsic hand muscle function progressively recovered, and one-year imaging confirmed complete resolution of the pseudoaneurysm. This case suggests that conservative management may be considered in carefully selected, hemodynamically stable patients without digital ischemia, provided that close clinical and radiological surveillance is feasible.