• Yeon Jin Jeong, Seong Hyuk Park, and Jun Yong Lee.
• Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
• Medicine (Baltimore). 2017 Apr 1; 96 (14): e6324.

RationaleSlowly progressive hand ischemia is mostly associated with medical illness such as vasculitis, and in patients with smoking history, Buerger disease is often considered first. However, despite the very low incidence of vascular anatomical anomalies, they can lead to hand ischemia. And if there is no consideration for them, proper treatment cannot be selected.Patient ConcernsA 42-year-old male smoker presented with a slowly progressing 5th fingertip necrosis following blunt trauma.DiagnosesAngiography revealed congenital hypoplasia of ulnar artery, and excluded Buerger disease or hypothenar hammer syndrome.Interventions And OutcomesWe reconstructed the necrotic fingertip using a 2nd toe pulp free flap to reflect the patient's need.LessonsIn this case report, the authors emphasize that the possibility of anatomical anomaly should be considered as a cause of the ischemia. Vascular imaging should be undertaken to investigate the cause of ischemia of the hand.

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