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Ulnar artery revascularization in hypothenar hammer syndrome has repeatedly been shown to reduce ischaemic symptoms, however with varying graft patency percentages. This study prospectively assesses the effect of revascularization surgery with a vein graft using validated questionnaires in seven patients. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Cold Intolerance Symptom Severity (CISS) questionnaires have been used to compare the preoperative and postoperative functionality and cold intolerance. All patients showed improvement in either functionality, or cold intolerance, or both from disabled to nearly normalized levels and resumed their occupation at final follow-up (mean of 28 months). Strikingly this was also the case in a patient with graft stenosis. Patients with the highest preoperative questionnaire scores showed most postoperative improvement. In conclusion, revascularization surgery seems to improve the symptomatology irrespective of graft patency. Questionnaires can be a valuable contribution to quantify and to follow the symptomatology in hypothenar hammer syndrome.

Pisotriquetral disorders can cause chronic ulnar-sided wrist pain. When conservative treatment is insufficient, pisiform excision can be a solution. There are reports found in the literature describing variable effects of this procedure in small, descriptive case series. This study included 175 patients who underwent pisiform excision performed in various specialized private hand clinics between 2011 and 2015. Patients were analyzed using standardized outcome measurements. Functionality was improved significantly 3 months postoperative, with a decrease in pain (n = 86) (P < 0.05), mean improvement of 13 degrees in wrist flexion/extension (n = 72) (P < 0.001), and 18% increase in strength (n = 75) (P < 0.001). Twelve months postoperatively, the wrist function (PRWHE-DLV) improved from a mean of 64 to 25 (n = 62) (P < 0.001). The results support pisiform excision as an effective and safe treatment. Significant pain relief can be expected with improvement in wrist function. Unfortunately, a high amount of data was missing. The authors believe that the data presented in the study represents an underestimation of the results. Level of evidence: Level III, therapeutic study.

Summary Background Surgical resection of skin tumors in the medial canthal area may damage the lacrimal duct and can result in chronic epiphora. Postoncologic reconstruction of the lacrimal duct has not been studied extensively. The current study discusses the anatomical and functional features of the lacrimal duct. It describes short-term functional outcomes after monocanalicular reconstruction of the lacrimal duct in a case series of 10 patients. Methods From February 2015 to October 2017, all patients with a postoncological lacrimal duct defect were analyzed to make an anatomical classification. The functional outcomes of patients after monocanalicular reconstruction were measured with the Munk scale up to 3 months after stent removal. Results Twelve patients had lacrimal duct defects after Mohs resection. Anatomical characteristics were used to create a clinical classification for lacrimal duct defects. This classification divides the upper (U) and lower (L) proximal lacrimal duct into two sections which can be damaged: the punctum and pars verticalis (1), the canaliculus horizontalis (2), or combined (3). The Common lacrimal duct (C) is the distal part of the lacrimal duct and can also be affected. Ten patients were analyzed after lacrimal duct reconstruction. Three months after stent removal, none of the patients suffered from epiphora. Conclusions This article proposes an anatomical classification for lacrimal duct defects in the proximal lacrimal drainage system. The classification can be applied in comparing cases and determining reconstructive strategies after oncologic skin tumor resection. Short-term results are promising for future efforts to reconstruct the lacrimal duct.

We present a 49-year-old woman with a cutaneous horn on the right shoulder since 20 years. Cutaneous horn is a clinical diagnosis referring to a benign or malignant lesion of the skin with a conical projection of cornified material. It is most common on sun-exposed skin.