Hypothenar hammer syndrome after radial forearm flap harvest: A case report

A case of acute hypothenar hammer syndrome (HHS) in a high-risk laborer in whom the radial artery had been surgically removed during a prior radial fo rearm flap harvest is reported. Studies estimating the true incidence of HH S among laborers are reviewed to define the risk of this complication. Two major risk factors must be considered in the assessment of a patient for ra dial forearm flap harvest. First, the risk for immediate vascular compromis e is determined by using a standard Alien's test to assess ulnar artery con tribution to hand perfusion. Second, the risk for future vascular compromis e is determined. When patients at high risk for HHS are recognized the surg eon should consider other reconstructive alternatives. If the superficial p almar arch is patent and complete and a radial forearm flap is performed, p ostoperative activity modification and risk counseling should be provided. Copyright (C) 2001 by the American Society for Surgery of the Hand.