From the Research
Forearm fasciotomy should be performed as early as possible, ideally within 4-6 hours of elevated compartment pressures, to prevent irreversible ischemic damage to muscles and peripheral nerves, as supported by the most recent study 1. The procedure involves making incisions through the skin and fascia to decompress the affected compartments, typically the volar (anterior) and dorsal (posterior) compartments of the forearm.
Key Considerations
- The most common approach is the volar-ulnar (Henry) approach for the superficial and deep volar compartments, and the dorsal (Thompson) approach for the dorsal compartment.
- After decompression, the wounds are typically left open and covered with moist dressings, with delayed primary closure or skin grafting performed 3-5 days later once swelling subsides.
- Compartment pressures exceeding 30 mmHg or a difference between diastolic blood pressure and compartment pressure of less than 30 mmHg, along with clinical symptoms such as pain out of proportion to injury, paresthesia, pallor, paralysis, and pulselessness, indicate the need for fasciotomy.
- A study published in 2019 2 found that the likelihood and severity of acute compartment syndrome are comparable in the leg and the forearm, highlighting the importance of prompt treatment regardless of the affected limb.
- Another study from 2012 3 identified risk factors for requiring split-thickness skin-grafting and the development of complications after fasciotomy, including younger age, crush injury, and delay in fasciotomy of more than six hours.
- However, a more recent study from 2021 1 presented a lateral S-shaped approach for fasciotomies of the 3 forearm compartments in the case of acute forearm compartment syndrome, which may offer a more effective and less invasive treatment option.
Potential Complications
- Delayed fasciotomy can lead to permanent functional loss, contractures, infection, or even need for amputation.
- The analysis from 2019 4 revealed a statistically significant higher likelihood of unfavorable outcomes resulting from performing fasciotomy in the event of forearm compartment syndrome compared with conservative management.
- Therefore, it is crucial to carefully weigh the risks and benefits of fasciotomy and consider the most recent and effective treatment approaches, such as the lateral S-shaped approach presented in the 2021 study 1.