Heinzel Johannes C, Lauer Henrik, Kolbenschlag Jonas, Daigeler Adrien, Bauer Michael R
From the Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, University of Tuebingen, Tuebingen, Germany.
Plast Reconstr Surg Glob Open. 2025 Aug 12;13(8):e7049. doi: 10.1097/GOX.0000000000007049. eCollection 2025 Aug.
In this article, we report a case of severe median nerve compression in the forearm caused by a large hematoma resulting from an iatrogenic pseudoaneurysm of the radial artery. Two weeks before presenting to our emergency room with neuropathic pain and persistent numbness of the palm, thumb, index, and middle fingers, as well as thumb motor deficits, the patient had undergone wrist denervation at an external outpatient clinic. Duplex ultrasound indicated a large pseudoaneurysm of the radial artery, which was confirmed by computed tomography angiography. The patient underwent emergency surgery, including evacuation of the hematoma compressing the median nerve beneath the forearm fascia, repair of the injured radial artery, and decompression of the median nerve. The procedure also included a carpal tunnel release. The patient experienced symptom improvement immediately after surgery. By the third postoperative day, when discharged, sensation in the median nerve distribution was equal bilaterally as assessed by the TEN-test, and he was able to abduct his thumb using the abductor pollicis brevis muscle. This article highlighted a relatively rare complication following wrist denervation surgery. Because this procedure involves exposure of the radial artery, there is an increased risk for iatrogenic pseudoaneurysm. This case also illustrated the diagnostic steps and microsurgical expertise required to manage such complications and to prevent severe damage to the median nerve through early decompression.
在本文中，我们报告了一例因桡动脉医源性假性动脉瘤形成的巨大血肿导致前臂正中神经严重受压的病例。在因神经性疼痛、手掌、拇指、示指和中指持续麻木以及拇指运动功能障碍而到我们急诊室就诊的两周前，患者在一家外部门诊接受了腕部去神经支配手术。双功超声显示桡动脉有一个巨大的假性动脉瘤，计算机断层血管造影证实了这一点。患者接受了急诊手术，包括清除压迫前臂筋膜下正中神经的血肿、修复受伤的桡动脉以及正中神经减压。该手术还包括腕管松解。患者术后症状立即改善。术后第三天出院时，通过TEN试验评估，正中神经分布区域的双侧感觉相等，并且他能够使用拇短展肌外展拇指。本文强调了腕部去神经支配手术后一种相对罕见的并发症。由于该手术涉及桡动脉的暴露，医源性假性动脉瘤的风险增加。本病例还说明了处理此类并发症以及通过早期减压防止正中神经严重损伤所需的诊断步骤和显微外科技术。
