Emergency Fasciotomy

Aka: Emergency Fasciotomy, Fasciotomy

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II. Indications

  1. Acute Compartment Syndrome (Third Degree Burn, Major extremity Trauma)
    1. See Compartment Syndrome for Fasciotomy indications

III. Technique: Forearm

  1. Identify Forearm Compartments
    1. Volar Compartment (flexors)
      1. Tissue anterior to ulna and radius
    2. Dorsal Compartment (extensors)
      1. Tissue posterior to ulna and radius
    3. Mobile Wad
      1. Tissue lateral to the radius
      2. Includes Brachioradialis Muscle, Extensor Carpi Radialis Muscles (brevis and Longus)
  2. Incisions
    1. First incisions cut through skin and subcutaneous tissue
    2. Second incisions cut through Muscle fascia
      1. Expect Muscles to extrude from wound in release of compartments under pressure
  3. Volar Incision
    1. S-Shaped starts distal to antecubital space and continue to thenar emminence
    2. Incision starts proximally at medial volar Forearm
    3. Incision curves towards lateral mid-Forearm
    4. Incision curves back to medial wrist
    5. Incision crosses to mid-wrist
    6. Incision follows thenar emminence and terminates proximal to first web space
  4. Dorsal Incision (if needed)
    1. Longitudinal incision from mid-dorsal Forearm to proximal dorsal wrist
    2. Two longitudinal incisions over the dorsal hand, parallel to the Metacarpals
      1. Between Metacarpals 2-3 and between 4-5

IV. References

  1. Kiel, Schneider, Clugston (2019) Crit Dec Emerg Med 33(6): 16-7

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