![]() ![]() The dorsal extensor compartment is approached through a dorsal midline straight incision – the mobile wad can usually be released via either the volar or dorsal approaches. Proximally, the lacertus fibrosus must be released as a possible site of compression as well as distally the carpal tunnel. This includes the investing fascia of individual fascial compartments in the deep flexor muscles (PQ, FDP, FPL). In the more common forearm compartment syndrome, care must be taken to decompress both the superficial and deep components of the volar flexor compartment. Given the importance of maintaining joint motion in the upper extremities and protecting important neurovascular bundles which could be exposed by nonjudicious incisions, recommendations are to perform curvilinear incisions and to avoid crossing flexion creases in a straight fashion.Īt the brachium level, three compartments are described: the volar (anterior) compartment containing the biceps and brachialis and coracobrachialis, which is released through an anterior or anterolateral approach, the posterior compartment with the three heads of the triceps, and the deltoid compartment – the latter two can be decompressed through a posterolateral approach taking care to release the tight epimysium of the deltoid compartment. Care must be taken not to add morbidity by injuring cutaneous branches in the forearm (e.g., MABC/LABC) and to decompress all components of the compartment. General recommendations for the upper extremity are similar to concepts of fasciotomy elsewhere in the body in that surgical decompression must be performed through adequate incisions which parallel the length of the fasciotomy incisions. If medical optimization is unsuccessful or the patient presents with an acute CS, fasciotomy must be performed as emergent procedure to decompress tissues and salvage tissue function. Further elevation will reduce perfusion pressures, reduce differential pressures, and thereby increase tissue damage. This includes full resuscitation, optimization of blood pressure and oxygenation, as well as keeping the extremity at slight elevation (heart level). As the provision of tissue oxygenation is key to prevention of a CS, medical optimization of a patient is of paramount importance. This includes removing all constrictive dressings and tight splints. Ĭlose observation with documented hourly repeat exams of a patient with concerns for a pending CS is mandatory. With regard to the most commonly affected deep flexor compartments in UECS, safe techniques for pressure measurement have been described. So standardization of measurement methods and sites is recommended for repeat measurements. In addition, it was shown that pressures measured within a single compartment can vary significantly with regard to distance to fracture site. When using pressure measurement devices, the higher accuracy of side port or slit catheters as compared to straight catheters has been pointed out. The absolute pressure theory as described by Matsen has been replaced by differential pressure models in which fasciotomy is indicated when the delta pressure, measured as the difference between the compartmental pressures and arterial or venous blood pressures, falls to 30 and 20 mmHg, respectively. Pressure measurements – especially in the obtunded patient – remain an important adjunct to CS diagnosis. The classic signs of compartment syndrome (“5 or 6 Ps”) included late irreversible changes and are not recommended in diagnosing early compartment syndrome. Additionally, wound closure has many proposed options, but current literature favors skin staples with an interlaced elastic band to minimize delays in wound closure.Given the importance of early intervention before irreversible damage has incurred, the diagnosis of CS in the upper extremity relies primarily on the recognition of clinical scenarios where a CS can be expected in combination with detection of early clinical signs such as pain to stretch – increasing pain out of proportion and increased analgesic needs. We conclude with a discussion about how medial release of the thigh for compartment syndrome is rare enough that careful consideration of the anatomy must be made before proceeding with the procedure. Given the rarity of compartment syndrome in all seven compartments of the leg, in this case, we report the development of full leg compartment syndrome in a 29-year-old male who fell asleep on a hard surface for an extended period following heroin intoxication, which was treated with seven compartment fasciotomies. ![]() Fasciotomy of the medial compartment of the thigh is exceedingly rare, and a review of the literature revealed only one reported case where compartment syndrome was present in both the thigh and lower leg compartments simultaneously. Compartment syndrome of the lower extremities is a condition that can lead to permanent nerve and muscle damage if not treated in an emergent fashion. ![]()
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