Forearm Compartment Release - Fasciotomy

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TECHNIQUE STEPS
 
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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Execute surgical walkthrough

  • describe key steps of the procedure to the attending verbally prior to the start of the case
  • describe potential complications and the steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • curved mayo scissors

2

Room setup and equipment

  • standard OR table
  • hand table

3

Patient positioning

  • patient supine
G

Ulnar Volar Incision

1

Mark and make the incision

  • make a straight line incision over the first third of the ulnar aspect of the volar forearm
  • start the incision just proximal to the wrist crease and extend the incision to just distal to the ulnar aspect of the elbow flexion crease

2

Identify the volar compartment

  • carry the incision down through the fascia into the volar compartment
H

Deep Dissection

1

Open the fascia

  • open the fascia along the length of the compartment

2

Examine the soft tissues

  • examine the deep and the superficial muscles
I

Radial Incision

1

Mark and make the second volar incision

  • make a second incision starting with a middorsal straight line incision that begins 3 to 4 cm proximal to the wrist crease

2

Extend the incision

  • extend the incision down to the radial aspect of the flexion crease
J

Fascial Release

1

Release the compartments

  • release the mobile wad and dorsal compartment

2

Incise the fascia

  • incise the fascia for both compartments over the entire length of the incision
  • examine the muscles in both compartments
  • after release of the fascia, the muscles should bulge out of the incision
  • do not debride any muscle during this procedure
  • some muscles with questionable viability may recover after the fascial release
K

Wound Management

1

Pack the wounds

  • pack the wounds with moist dressing until the second look procedure
L

2nd Look Procedure

1

Debride necrotic tissue

  • aggressively debride any necrotic tissue with a no. 10 blade in a tangential manner until bleeding tissue is seen

2

Cover the wounds

  • place moist dressings over large wounds with exposed deep structures of neurovascular structures until coverage can be performed
  • if coverage is not needed, perform moist dressing changes for the next 7 to 14 days once the edema subsides, perform primary closure or skin grafting as needed
Postoperative Patient Care
 

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