From the Research
For suspected compartment syndrome of the arm, fasciotomy incisions should be made along the volar and dorsal aspects of the forearm, as this approach is supported by the most recent and highest quality study available 1. The volar incision should extend from the antecubital fossa to the wrist, slightly ulnar to the midline, allowing access to the superficial and deep volar compartments.
- The dorsal incision should run from the lateral epicondyle to the wrist, providing access to the dorsal and mobile wad compartments.
- These incisions must be made through skin, subcutaneous tissue, and fascia, with careful attention to avoid neurovascular structures, particularly the median nerve volarly and the superficial branch of the radial nerve dorsally. Complete fascial release is essential, as inadequate decompression can lead to continued tissue ischemia, as highlighted in 2 and 3. The skin should be left open, with plans for delayed primary closure or skin grafting once swelling subsides. This approach is necessary because compartment syndrome causes increased pressure within the fascial compartments, compromising blood flow and potentially leading to irreversible muscle and nerve damage if not promptly addressed, as noted in 4 and 5. The goal of fasciotomy is to immediately relieve this pressure and restore tissue perfusion, which is critical for preventing long-term morbidity and mortality, as emphasized in 1.
Key considerations in the management of suspected compartment syndrome include:
- Prompt recognition and diagnosis, as delayed treatment can lead to irreversible damage 2
- Careful planning and execution of fasciotomy incisions to avoid neurovascular structures and ensure complete fascial release 3
- Post-operative management, including wound care and plans for delayed primary closure or skin grafting, to optimize outcomes and minimize complications 1