A Rare Case of Neglected Posttraumatic Ulnar Artery Pseudoaneurysm in the Proximal Forearm: Surgical Challenges and Management

Pseudoaneurysms of the ulnar artery are rare vascular complications, typically following penetrating trauma. Chronic, neglected pseudoaneurysms presenting after several years are extremely uncommon and can lead to diagnostic delay and operative complexity. A 35-year-old male presented with a gradually enlarging, pulsatile swelling over the medial aspect of the right proximal forearm. He had sustained penetrating trauma in the same region 10 years prior. Imaging confirmed a large pseudoaneurysm arising from the ulnar artery with partial thrombosis and reduced distal flow. Surgical exploration confirmed a pseudoaneurysm measuring approximately 7 cm × 6 cm, embedded within the intermuscular plane. The lesion was adherent to the surrounding tissues, with the ulnar nerve located along its inferior aspect and carefully dissected free. Due to the absence of distal flow, the ulnar artery was not reconstructed. Collateral perfusion via the radial artery and deep palmar arch was intact. This case highlights the importance of considering vascular lesions in chronic posttraumatic swellings and demonstrates the feasibility of excision without reconstruction in the presence of adequate collateral circulation.