From the Research
For suspected compartment syndrome of the arm, fasciotomy incisions should be made to decompress both the volar (anterior) and dorsal (posterior) compartments. The volar incision should extend from the antecubital fossa to the palmar crease, curving slightly ulnarly at the wrist to avoid the palmar cutaneous branch of the median nerve, as described in various studies 1, 2, 3, 4, 5. This incision allows access to decompress the superficial and deep volar compartments. The dorsal incision should be made along the lateral aspect of the forearm from the lateral epicondyle to the wrist, allowing decompression of the mobile wad (brachioradialis, extensor carpi radialis longus and brevis) and the dorsal compartment. Key considerations for these incisions include:
- Making them through skin, subcutaneous tissue, and fascia
- Taking care to protect underlying neurovascular structures
- Ensuring complete fascial release to prevent continued tissue ischemia After fasciotomy, the wounds are typically left open and covered with moist dressings, with delayed primary closure or skin grafting performed later, as noted in 4. Prompt surgical decompression is critical because muscle necrosis can occur within 4-6 hours of elevated compartment pressures, leading to permanent functional impairment, a point emphasized by the most recent and highest quality study 4.