What Is a Fasciotomy?

Forearm ischemic contracture is a sequela of forearm acute fascial compartment syndrome. If early treatment can be given properly, the occurrence of ischemic contracture can be greatly reduced or avoided. The early and reasonable treatment is derived from the early diagnosis. For the following cases, the possibility or existence of acute fascial compartment syndrome in the forearm can be considered: patients with elbow, arm fractures, dislocations or sprains, suffering from arm swelling and pain 2. The flexion and extension of fingers is limited; when the fingers are passively extended or flexed, it causes severe pain on the palm or dorsal side of the forearm; there is tenderness in the abdomen of the affected extensor and flexor muscles; Fingertips are cold and cyanotic, feeling dull or lost, the intra-fascial pressure exceeds 30-60mmHg, and the radial artery pulsations are normal, weakening or disappearing. Especially after the above-mentioned injuries, when the fingers are passively flexed, severe pain on the palm or back of the forearm, progressive swelling of the forearm, high tension, and no depression are the main basis for making a correct diagnosis early.

Fascial compartment decompression

Right!

Forearm ischemic contracture is a sequela of forearm acute fascial compartment syndrome. If early treatment can be given properly, the occurrence of ischemic contracture can be greatly reduced or avoided. The early and reasonable treatment is derived from the early diagnosis. For the following cases, the possibility or existence of acute fascial compartment syndrome in the forearm can be considered: patients with elbow, arm fractures, dislocations or sprains, suffering from arm swelling and pain 2. The flexion and extension of fingers is limited; when the fingers are passively extended or flexed, it causes severe pain on the palm or dorsal side of the forearm; there is tenderness in the abdomen of the affected extensor and flexor muscles; Fingertips are cold and cyanotic, feeling dull or lost, the intra-fascial pressure exceeds 30-60mmHg, and the radial artery pulsations are normal, weakening or disappearing. Especially after the above-mentioned injuries, when the fingers are passively flexed, severe pain on the palm or back of the forearm, progressive swelling of the forearm, high tension, and no depression are the main basis for making a correct diagnosis early.

Fascial compartment decompression

Orthopedics / Hand Surgery / Advanced Repair of Hand Injury / Surgery Treatment of Forearm Ischemic Contracture / Acute Surgery of Forearm Ischemic Contracture

83.0901

Forearm ischemic contracture is a sequela of forearm acute fascial compartment syndrome. If early treatment can be given properly, the occurrence of ischemic contracture can be greatly reduced or avoided. The early and reasonable treatment is derived from the early diagnosis. For the following cases, the possibility or existence of acute fascial compartment syndrome in the forearm can be considered: patients with elbow, arm fractures, dislocations or sprains, suffering from arm swelling and pain 2. The flexion and extension of fingers is limited; when the fingers are passively extended or flexed, it causes severe pain on the palm or dorsal side of the forearm; there is tenderness in the abdomen of the extensor and flexor muscles, and the skin is flushed, ecchymosis, and tension blister. Fingertips are cold and cyanotic, feeling dull or lost, the intra-fascial pressure exceeds 30-60mmHg, and the radial artery pulsations are normal, weakening or disappearing. Especially after the above-mentioned injuries, when the fingers are passively flexed, severe pain on the palm or back of the forearm, progressive swelling of the forearm, high tension, and no depression are the main basis for making a correct diagnosis early.

For forearm acute fascial compartment syndrome, in addition to general treatment, timely fascial compartment incision and adequate decompression are an important and indispensable part of early treatment, and the only way to prevent late complications of ischemic muscle contracture Reliable method.

Surgery related anatomy.

Fascial compartment decompression is suitable for:

1. The fascial compartment is highly swollen, tender, and severely painful, and the wrist muscles of the extensor and flexion are weakened, the fingers are chilled, cyanosis, and the fingers are in flexion. .

2. The affected limbs swell progressively, the abdomen of the muscles becomes stiff, and the limbs become sleeve-like feeling diminished or disappear. Radial artery pulsation weakened or disappeared. Sometimes although the radial artery pulsations are normal, the muscles are also markedly ischemic. Because when the forearm flexor fascia room tension is normal, the small arterial branch of the main artery of the forearm is opened to maintain the blood supply to the muscles. When the forearm swells and the intra-fascial pressure increases to a certain extent, although the main arteries still have blood flow through, the small arteries of the vegetative muscles are closed and the muscles are in a severe ischemic state. Therefore, we must not ignore the other clinical manifestations to delay the timing of surgery because of the existence of radial artery pulsation.

3. Room pressure between fascia> 40mmHg, or tissue pressure rise to a level between 10-30mmHg below diastolic pressure.

1. Strengthen systemic treatment, including blood transfusion, infusion, correction of shock, acidosis and hyperkalemia, prevention and correction of acute renal failure.

2. Systemic application of antibiotics.

3. Prepare a room pressure measuring device and measure the room pressure between the fascias at the same time and make a record.

Brachial plexus or local anesthesia or general anesthesia. For coma or neural stem damage caused by loss of sensation, local incision decompression can be done directly.

In the supine position, the upper limbs are placed on the chest or abducted on the side table.

1. Forearm palmar fascial compartment incision (Decompression of VolarFascialComparmentofForearm)

(1) Incision: Single incision decompression method is often used, and an improved Gelberman surgical incision is commonly used. The skin incision starts from the outside of the biceps tendon above the elbow fossa, obliquely across the elbow fossa, to the pronator circular and flexor muscles above the forearm, and then gradually turns to the outside, reaching the midline at the mid-lower third of the forearm , Then continue straight down and extend inside the palmar long muscle to reach the proximal wrist transverse line and then meander and extend to reach the middle of the palm.

(2) In the designed incision line, cut the skin, subcutaneous tissue and deep fascia in full length, and open the carpal tunnel at the same time. Avoid cutting the superficial subcutaneous vein as much as possible. Cut the biceps aponeurosis obliquely to remove the hematoma. It can be seen that the gray ischemic superficial muscle immediately resumes blood circulation and reactive hyperemia occurs. Due to the high intra-fascial tension, muscles can bulge through the incision. If the deep muscles are still gray and ischemic at this time, care should be taken to longitudinally cut the extramuscular membranes of these muscles to restore blood flow to the deep muscles. When cutting the epicardium, be careful not to damage the nerve branches that penetrate the epicardium and enter the muscle. If the blood supply to the muscles does not improve significantly after fascia and epimyotomy, the brachial artery should be immediately explored, and the brachial artery is exposed at the elbow on the deep side of the biceps aponeurosis and on the medial side of the biceps and brachialis. If brachial artery spasm, contusion, partial rupture or complete rupture occurs due to compression of the fracture end or direct puncture of the blood vessel, the fracture should be reduced and fixed internally, and then given appropriate treatment according to different situations. If the median and ulnar nerves have sensory disturbances and paralysis of the internal muscles of the hand, the entrapment should be fully relieved around the four sides, that is, the proximal edge of the biceps brachialis fascia and the pronator round muscle, which refers to the proximal edge of the superflexor And wrist, ulnar tube. If necessary, open the outer nerve membrane to release the nerve. Manage local fractures, dislocations, or hemostasis. Fill the muscle space with a vaseline gauze strip, or use a rubber membrane tube or a silicone tube for drainage. The incision was not sutured, covered with a sterile dressing, and gently bandaged.

2. Forearm dorsal fascial compartment incision (DecompressionofDorsalFascialCompartmentofForearm)

(1) Incision: Starting from the distal 2cm of the lateral epicondyle, the straight line extends 7-12 cm to the midline of the wrist.

(2) Cut the skin, subcutaneous tissue and deep fascia layer by layer along the designed incision line, reaching the muscle abdomen such as the total extensor muscle, the supinator muscle, and the extensor wrist muscle. Check the area for fractures, dislocations, bleeding, compression, and deal with them accordingly. If the back of the hand is severely swollen and the pressure of the interosseous muscle is still high, the forearm dorsal incision can be extended to the tiger's mouth and the fourth metacarpal ulnar side, and the deep fascia is cut at the same time. Measure the pressure in each chamber. If the pressure has been completely reduced, the wound is drained without incision.

(3) Cover with sterile gauze bandage. Plaster or splint for elbow, forearm and wrist

1. During the operation, it is found that the blood vessels have spasm. Local wet and hot compresses can be applied, and procaine is locally closed. Or, local compresses with vasodilators can be used. If blood vessels have formed emboli, they should be removed. Vascular rupture should be repaired or revascularized. However, damp and hot compresses are not allowed for ischemic affected muscles, so as not to accelerate muscle necrosis.

2. While performing fasciotomy, when you see that individual muscles swell obviously need decompression, you should also perform decompression of the muscle epithelium.

3. For patients with neurosensory and motor dysfunction, while performing fasciotomy, nerve exploration should be routinely performed, and at the same time, adventitia decompression and decompression should be performed to reduce or avoid residual nerves. Dysfunction or burning neuralgia.

4. Intraoperative fascia should be fully incision to achieve the purpose of adequate decompression. During decompression surgery, if muscle necrosis is shown, it should be completely removed. If the patient is allowed to liquefy, it will easily lead to infection and bring serious consequences. If the muscle necrosis is too extensive, it can be resected in stages when all the resections will cause serious effects.

5. The use of tourniquet is prohibited during the operation.

6. If the fracture has been fixed internally, postoperatively use plaster or a small splint to fix the forearm and hand at the functional position. If internal fixation is not performed, bone traction is performed at the elbow flexion position, and the traction weight is 1 to 2 kg. As long as the fracture alignment is maintained, anatomical reduction is not required. Because poor fracture reduction is less important than ischemic muscle contractures. After the swelling subsides and the circulation is good, use plaster to fix it. Early strengthening exercise.