Progressive fingertip necrosis after nail avulsion injury in a patient with ulnar artery hypoplasia

RATIONALE Slowly 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 CONCERNS A 42-year-old male smoker presented with a slowly progressing 5th fingertip necrosis following blunt trauma. DIAGNOSES Angiography revealed congenital hypoplasia of ulnar artery, and excluded Buerger disease or hypothenar hammer syndrome. INTERVENTIONS AND OUTCOMES We reconstructed the necrotic fingertip using a 2nd toe pulp free flap to reflect the patient's need. LESSONS In 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.