Kevin D. Plancher

History and Clinical Presentation

A 38-year-old left hand dominant woman is seeking treatment for a tender mass in the palm of her hand. The patient had fallen with a glass bottle in her hand 2 weeks earlier and had sustained a puncture wound to the ulnar aspect of her right palm. At that time active arterial bleeding persisted despite direct pressure on the wound with a compressive dressing. She was originally treated in the emergency department with irrigation and exploration with cauterization of a "superficial" vessel and wound closure.

Physical Examination

Removal of her sutures of the skin resulted in pulsatile bleeding from the wound. The bleeding continued despite direct manual compression on the wound (Fig. 24—1). Manual compression of the ulnar and radial arteries individually at the wrist crease did not stop the bleeding. Bleeding only ceased with manual compression of both arteries. The Allen's test was performed and found the ulnar artery not patent. The color of the hand when performing the Allen's test, to the ulnar side of the wrist, showed lack of perfusion to the radial side of the wrist (Fig. 24-2).

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