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Technique of Forearm Fasciotomy

- see forearm compartment syndrome;

- Discussion:
    - see forearm flexors
    - 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 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