Arm Compartment Release - Anteromedial Approach

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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
  • arm board

3

Patient positioning

  • patient supine
G

Antermodial Approach

1

Mark and make the incision

  • Make the incision from the medial epicondyle towards the axilla
H

Deep Dissection

1

Split the fascia

  • split the fascia that overlies the biceps and the triceps

2

Protect the neurovascular structures

  • isolate and protect the ulnar nerve

3

Check the integrity of the soft tissue

  • check the viability of the muscle
  • check the muscle tone, contractility, color and bleeding
  • if viability of the muscle tissue is not clear, reinspect the muscle in 24 to 48 hours

4

Leave the incision open

I

Wound Management

1

Copiously irrigate the wound

2

Cover the incision with wet saline dressings

  • another option is to use a wound vac
  • this can be done to facilitate care, reduce the edema and decrease the pain that is associated with frequent dressing changes
J

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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