Fasciotomy: Upper Extremity
Fasciotomy: Upper Extremity
David Ray Velez, MD
Table of Contents
Upper Arm Fasciotomy
Upper Arm Compartments (x3)
- Anterior (Flexors)
- Posterior (Extensors)
- Deltoid
Upper Arm Fasciotomy Technique
- Single Lateral Incision from the Deltoid Insertion to the Lateral Epicondyle
- Incise the Anterior Fascia to Release the Anterior Compartment
- Incise the Posterior Fascia to Release the Posterior Compartment
Upper Arm Compartments
Upper Arm Fasciotomy
Forearm Fasciotomy
Forearm Compartments (x3)
- Volar (Flexors)
- Dorsal (Extensors)
- Lateral/Mobile Wad (Brachioradialis and Extensor Carpi Radialis Muscles)
The Volar Compartment is the Most Commonly Affected
The Lateral Compartment (Mobile Wad) is Rarely Affected
Forearm Fasciotomy Technique
- Volar (“Henry”) Incision:
- Start Proximal Over the Medial Epicondyle
- ‘S’ Curve Laterally Over Antecubital Fossa and Extended Back Medially Over the Forearm
- Finish Over the Palmar Crease
- Incise the Fascia of the Volar and Lateral Compartments to Release Each
- May Consider a Carpal Tunnel Release to Decompress the Median Nerve
- Dorsal Incision:
- Single Vertical Incision
- Incise the Dorsal Fascia to Release the Dorsal Compartment
Forearm Compartments
Forearm Fasciotomy
Hand Fasciotomy
Hand Compartments (x10)
- Thenar
- Hypothenar
- Dorsal Interosseous x4
- Volar Interosseous x3
- Adductor Pollicis
Hand Fasciotomy Technique
- Two Longitudinal Dorsal Incisions Over 2nd/4th Metacarpals
- Longitudinal Incision Over Medial Aspect of 5th Metacarpal
- Longitudinal Incision Over Lateral Aspect of 1st Metacarpal
- Tailor Fasciotomies to Symptoms
- All Should Also Have Carpal Tunnel Release
Hand Compartments 1
Hand Fasciotomy
References
- Reichman EF. Compartment Syndrome of the Hand: A Little Thought about Diagnosis. Case Rep Emerg Med. 2016;2016:2907067. (License: CC BY-4.0)