- Discussion;
- in forearm, both volar & dorsal compartments must be relieved by two
incisions placed at 180 deg to each other;
- release of volar compartment may quell elevated dorsal compartment;
- on occasion,
dorsal fasciotomy is required;
- on volar surface, lacertus fibrosis (proximally) &
carpal tunnel (distally)
must be released;
- in upper extremity, need to decompress deep volar compartment (
FDP &
&
FPL) & perform epimysiotomy is not clear in literature available;
- deep fascia over
FCU, & in certain instances edge of
FDS, which may
compress median nerve and the median or radial arteries;
- Volar Incision:
- curvilinear incision is preferred because it allows exposure of all
major nerves, arteries, and the mobile wad;
- begins proximal to the antecubital fossa & extends to middle of palm;
- incision is
carried no farther radially than midaxis of ring finger to avoid
injury to the superficial palmar branch of the median nerve;
-
dorsal ulnar incision:
- allows better skin coverage over neurovascular bundles and tendons
after decompression;
-
lazy S shaped incision:
- extends from the proximal palmar ulnar forearm, gently curves across to
radial palmar forearm, returns to ulnar side, & then extends into mid
palm just ulnar to thenar crease;
- this incision allows freeing of superficial and deep flexor wads and
decompresses the median nerve by carpal tunnel release;
- Recheck Pressures:
- following volar fasciotomy, which is made in same line as skin incision,
compartment pressure is checked to acertain that all deep flexor
muscles have been decompressed;
- after volar decompression, pressure measurements of the volar
compartment, mobile wad, and dorsal compartments are repeated;
- Dorsal Incisions:
- dorsal, linear, longitudinal forearm incision is made between mobile
extensor wad & extensor digitorum communis muscle bellies;
- these are two separate compartments which must be opened individually;
- if pressure in the mobile wad and dorsal compartments are greater
than 15 mm Hg, these compartments are also decompressed;
- epimysiotomy of indvidual superficial & deep muscle bellies should be
performed;
- patient should be returned to the OR for a second look in 48 hrs;
