Upper Extremity Fasciotomy
Compartment syndrome results from the combination of increased interstitial tissue pressure and the noncompliant nature of the fascia and osseous structures that make up a fascial compartment, causing microvascular compromise and subsequent muscle and ner
- PDF / 153,057 Bytes
- 4 Pages / 504.567 x 720 pts Page_size
- 9 Downloads / 211 Views
121
Michele F. Chemali, Fady Haddad, and Amir Ibrahim
Indications
Possible Complications
1. Status post upper extremity revascularization with compartmental hypertension 2. Crush injury with concomitant fracture and severe soft tissue damage 3. Circumferential burn with delayed care and compartment syndrome 4. Warm ischemia secondary to vessel injury for more than 4–6 h 5. Tense compartment/compartment pressures exceeding 40 mmHg
1. Nerve injury 2. Bleeding 3. Infection and wound healing complications 4. Exposure of vital structures 5. Volkmann’s ischemic contracture if performed late after a delayed diagnosis
Essential Steps Preoperative Marking
M.F. Chemali, M.D. General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon F. Haddad, M.D. Clinical Surgery (Vascular and Endovascular Surgery), Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon A. Ibrahim, M.D. (*) Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon e-mail: [email protected]
1. Upper arm: mark a line between deltoid insertion and the lateral epicondyle. 2. Forearm: (a) Volar approach: – Mark the crease between the thenar and hypothenar eminence and palmaris longus (if the patient has one) for carpal tunnel decompression. – Draw a curvilinear line extending transversely across the wrist flexion crease to the ulnar side of the wrist, then arched across the volar forearm, back to the ulnar side at the elbow just radial to the medial epicondyle, and finally across the antecubital fossa. (b) Dorsal approach: Draw a line from the lateral epicondyle between the extensor
© Springer International Publishing Switzerland 2017 T.A. Tran et al. (eds.), Operative Dictations in Plastic and Reconstructive Surgery, DOI 10.1007/978-3-319-40631-2_121
485
486
digitorum communis (EDC) and extensor carpi radialis brevis (ECRB), extending distally approximately 10 cm toward the midline of the wrist. 3 . Hand: (a) Draw a line on the radial side of the thumb metacarpal for the release of the thenar compartment. (b) Draw a line over the index finger metacarpal for the release of first and second dorsal interossei. (c) Draw a line over the ring finger metacarpal for the release of third and fourth dorsal interossei. (d) Draw a line at the ulnar aspect of the small finger metacarpal to release hypothenar muscles.
Intraoperative Details 4 . Placed in supine position 5. General anesthesia or monitored anesthesia care 6. Arm: (a) Lateral skin incision from deltoid insertion to the lateral epicondyle. (b) Spare larger cutaneous nerves. (c) At fascial level, the intermuscular septum between the anterior and posterior compartment is identified, and the fascia overlying each compartment is released with longitudinal incisions; protect the radial nerve as it passes through the intermuscular septum from the posterior compartment to anterior compartment just below the fascia. 7. Forearm: longi
Data Loading...
