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History

A 20 year-old right-hand dominant female sustained a laceration to the ulnar aspect of her middle and distal right forearm upon accidentally falling through a window pane. At initial presentation, the patient was felt to be neurovascularly intact, including in the ulnar nerve distribution; her laceration was washed out and primarily closed. Upon follow-up with a hand specialist later that week, the patient complained of numbness in the ulnar digits, as well as weakness and pain in the hand. On physical examination, the patient lacked ulnar distribution pinprick sensation, demonstrated weak abduction of the digits, and was unable to cross her fingers. Perfusion to the hand was adequate. An ulnar nerve laceration was suspected, and the patient was taken to the OR for exploration approximately 2 weeks later. Lacerations to the ulnar artery and nerve were found, as well as to the flexor carpi ulnaris (FCU) tendon and small finger flexor digitorum superficialis (FDS) tendon. Under microscope visualization, the nerve stumps were trimmed back until healthy fascicles were present. A 1 cm gap was present between the nerve ends, which could not be re-approximated without tension. A 4 mm diameter commercially available collagen conduit was used to bridge the gap and was secured with 8-0 nylon epineural sutures. Additionally, the patient received tendon repairs and microsurgical ulnar artery repair. Postoperatively, the patient had no complications but failed to demonstrate ulnar nerve recovery. Approximately 3 months after her initial repair, she was referred to our institution.