Compartment Syndrome Of Forearm Research Articles

Flow-Through Procedure in Sequela After Complex Injuries of the Hand With Fingers’ Amputation

PurposeComplex injuries of the hand with finger amputation can result in important functional impairment. If the amputated fingers cannot be replanted, the developed sequelae should be further evaluated. Sometimes, in the presence of a few remaining local vascular resources, the use of the flow-through technique can help in solving the problem. MethodsThis study retrospectively reviews 4 cases who underwent single or multiple fingers reconstruction with toe transfers by using true flow-through or flow-through conduit flaps. A thorough description of the two methods is done, and the quality of the regained functionality of the hand is presented. ResultsAll the patients were males, aged between 21 and 45 (median age 31.75). One of them injured the left dominant hand, and the other three their right dominant hand. The median time between the accident and reconstructive surgery was 14.5 months (range, 3 months-36 months). All the initial lesions were work-related trauma. One patient had severe sequela after forearm compartment syndrome and amputation of the thumb and fifth finger; one patient had a metacarpal hand, one patient had amputation of two fingers (2nd and 4th); and one patient had three fingers amputated (2nd, 3rd, and 4th). In the first patient, a true flow-through flap and a second toe transfer was done, and in the other three patients multiple toe transfers by using the flow-through conduit technique were used. A good functionality of the reconstructed hand was obtained in all the patients. ConclusionsToe transfer remains one of the best methods in the reconstruction of hands with missing fingers. The use of both true flow-through flap and flow-through conduit methods are very useful, especially in cases with few vascular resources.

Updates in Diagnosis and Management of Forearm Compartment Syndrome

In children, compartment syndrome of the forearm often arises from supracondylar fractures, whereas in adults, distal radius fractures are the predominant cause. In 48% of instances, diagnosis was based exclusively on clinical assessment, while in the remaining 52% of cases, a combination of intracompartmental pressure measurement and clinical assessment was used. Several methods, including wick catheters, slit catheters, the Whitesides method, and the Stryker compartment pressure measurement device, were employed to measure intracompartmental pressure. The treatment approach of choice was fasciotomy, with a preference rate of 73%. Out of all the patients that needed wound management, postfasciotomy skin grafting was essential in 61% of them, while secondary closure was done in 39% of cases. The most prevalent consequence, observed in 21% of patients, was neurological impairment.

Nylon cable ties–assisted delay primary closure of fasciotomy wound in patients of forearm compartment syndrome

Abstract Background Forearm compartment syndrome is a rare condition that requires forearm fasciotomy to release compartment pressure. In most cases, there is little to no skin damage initially, but after the fasciotomy, the skin flap may gradually retract. Traditional methods for reconstructing fasciotomy wounds, such as skin grafts or flaps, often result in an unpleasant appearance and require donor sites. Materials and Methods We present a method using nylon cable ties for delayed primary closure of forearm fasciotomy wounds. We retrospectively reviewed patients who underwent fasciotomy of forearms for compartment syndrome and nylon cable ties–assisted closure in a medical center from January 2017 to December 2022. Results Of the 7 eligible patients, 4 suffered from compartment syndrome of the forearm because of iatrogenic vascular rupture after procedures, whereas the other reasons included open-type fracture and fasciitis. For all the patients, nylon cable ties were applied for delayed primary wound closure after emergent fasciotomy. Six of them achieved successful wound closure by nylon cable ties without skin grafts or flaps on median day 12 (days 6–19). Only 1 patient required skin graft reconstruction after the application of nylon cable ties for 10 days. Conclusions Nylon cable ties, which are inexpensive and readily available, can be adjusted according to the different tension along the wound edges. They provide a simple, effective, and safe way to close difficult forearm fasciotomy wounds, which often result in a retracting skin flap after the procedure.

Forearm Compartment Syndrome due to Transradial PCI in STEMI: Case Series of What Can Go Wrong and Lesson Learned

The trans-radial approach (TRA) is shown to be superior in reducing bleeding complications and associated with lower mortality with a similar procedural success rate in ST-Elevated Myocardial Infarction (STEMI) patients compared to the trans-femoral approach. Nevertheless, complications such as forearm hematoma and, in rare cases, acute compartment syndrome (ACS) may develop, thus requiring a prompt surgical procedure. Here, we present two successful emergency fasciotomy cases as ACS treatment following primary percutaneous coronary intervention after STEMI. Both patients show normal neurological and muscular function and normal artery flow on both hands afterward.

Surgical site infection following fasciotomy in patients with acute forearm compartment syndrome: a retrospective analysis of risk factors.

Fasciotomy, a standard therapy for acute forearm compartment syndrome (AFCS), can prevent serious complications, but there may be significant postoperative consequences. Surgical site infection (SSI) may cause fever, discomfort, and potentially fatal sepsis. This study aimed to identify risk factors for SSI in AFCS patients who had undergone fasciotomy. Patients with AFCS who had fasciotomies between November 2013 and January 2021 were recruited. We collected demographic information, comorbidities, and admission laboratory results. Analyses of continuous data were conducted using the t-test, the Mann-Whitney U test, and logistic regression analysis, while analyses of categorical data were conducted using the Chi-square and Fisher's exact tests. Sixteen AFCS patients (13.9%) suffered infections that need further therapy. Using the logistic regression analysis, we identified that patients with a history of diabetes (p = 0.028, OR = 16.353, 95% CI (1.357, 197.001)), open fractures (p = 0.026, OR = 5.239, 95% CI (1.223, 22.438)), and a higher level of TC (p = 0.004, OR = 4.871, 95% CI (1.654-14.350)) were the best predictors of SSI, while ALB levels (p = 0.004, OR = 0.776, 95% CI (0.653-0.924)) were protective for SSI in AFCS patients. Our results showed that open fractures, diabetes, and TC levels were relevent risk factors for SSI following fasciotomy in patients with AFCS, allowing us to personalize the risk assessment and apply early targeted interventions.

Acute forearm compartment syndrome presenting 2 weeks after penetrating arterial trauma.

Acute forearm compartment syndrome presenting 2 weeks after penetrating arterial trauma.

Ultrasound-guided fasciotomy for chronic exertional forearm compartment syndrome: a cadaveric feasibility study

ObjectivesChronic exertional forearm compartment syndrome is observed in patients who engage in physical activity requiring repetitive isometric muscular effort of the wrist during prolonged grasping. Open fasciotomy was considered as the gold-standard treatment, for its ability to release all compartments. However, its invasiveness means that high-level athletes have to abstain from competition for a long period of time. For this reason, minimally invasive techniques have been developed, to allow faster recovery.The objective of this cadaveric study was to evaluate the feasibility and reproducibility of ultrasound-guided palmar fasciotomy in the treatment of chronic exertional forearm compartment syndrome. MethodsSurgery consisted in ultrasound-guided palmar fasciotomy of the superficial anterior compartment, using a single minimally invasive approach. Twenty forearms were then dissected by an independent operator, (1) to check complete fasciotomy and (2) to screen for iatrogenic lesions on the tendons, veins and superficial sensory branches. ResultsSixteen fasciotomies were total and 4 partial: i.e., a release rate of 80%. The superficial sensory branches were intact, and notably the branches of the medial cutaneous nerve of the forearm. Mean surgery time was 9 min, progressively decreasing with the repetition of the ultrasound-guided procedure. ConclusionsUltrasound-guided fasciotomy in the management of chronic exertional forearm compartment syndrome appears to be a simple, effective, safe and reproducible technique.

Forearm compartment syndrome after a trans-ulnar coronary intervention in a patient with ST segment elevation myocardial infarction

Compartment syndrome is a very rare but possibly devastating complication of coronary angiography when a trans-radial approach is used. The trans-ulnar approach is an attractive option in cases with anatomic variations of the radial artery or weak radial pulses. Even though it is expected that the trans-ulnar approach has a similar risk of developing compartment syndrome like trans-radial approach, the literature does not have many case reports describing this complication. Here we report a case of a woman who developed forearm compartment syndrome after trans-ulnar coronary intervention in the setting of ST-segment elevation myocardial infarction.

Characteristics and outcomes of patients who undergo fasciotomies for upper arm compartment syndrome.

Describe the demographic, injury-related, treatment-related, and outcome-related characteristics of patients who undergo fasciotomies for acute upper arm compartment syndrome (ACS). From January 1, 2006, to June 30, 2015, 438 patients with a diagnosis code of upper extremity (including hand, forearm, arm, and shoulder) compartment syndrome at two tertiary care centers were identified. Of those patients, 423 were excluded for a diagnosis other than upper arm ACS or incomplete documentation. A final cohort of 15 adult patients with acute upper arm compartment syndrome treated with fasciotomy was included. The electronic medical record for patient-related variables, lab data, mechanism of injury, presence of additional injuries, and treatment-related variables were reviewed. The mean age of our cohort was 52years, and 73% were male. The most common mechanisms of injury were blunt trauma (20%), vascular injury (20%), oncologic resection (13%), and infection related to intravenous drug use (13%). Humerus fractures and biceps tendon ruptures were associated with 13 and 27% of the cases, respectively. More than two-thirds of the patients had elevated international normalized ratios (INR). While 27% of cases underwent fasciotomy within 6h after injury, seven patients (47%) underwent fasciotomy more than 24h after injury. Six patients had no major deficits, while 7 patients had long-term deficits. Upper arm ACS is a potentially devastating condition that can be seen after blunt trauma, vascular injury, oncologic resection, and intravenous drug use. Clinicians should have high suspicion in cases of elevated INR and biceps tendon rupture.

Early-stage reconstruction of flexor pollicis longus using palmaris longus in a patient with compartment syndrome of forearm: a case report

BackgroundThe flexor pollicis longus is the most vulnerable muscle in acute compartment syndrome of the forearm. Reconstruction of a dysfunctional flexor pollicis longus is occasionally necessary following compartment syndrome of the forearm.Case presentationA 42-year-old Japanese man injured his left forearm in a motor vehicle accident. Open radial shaft fracture and acute compartment syndrome of the left forearm was diagnosed. We performed a fascial release of the forearm and debridement of the involved myonecrosis of the flexor pollicis longus. At second-look operation (3 days after the initial release), we performed palmaris longus tendon transfer to the flexor pollicis longus tendon. At 6-month follow-up, the patient had no complaints and returned to his job. At 2-year follow-up, the patient had achieved 88% of pinch strength, compared with the contralateral hand, and scored 11.4 on the QuickDASH score.ConclusionsPalmaris longus transfer performed immediately after injury is simple and does not require an additional surgical approach. Hence, early palmaris longus tendon transfer, which can provide satisfactory outcomes, could be considered as a potential choice for flexor pollicis longus reconstruction in patients with compartment syndrome of the forearm.

A rare case of median nerve intraneural hematoma after stenting of right iliac artery

Aim: Brachial artery access is an alternative approach to endovascular interventions when access to the femoral, radial, or ulnar arteries is not feasible, but it carries higher risk of periprocedural complications than other approaches, including median nerve injury. Nerve injuries can occur by direct puncture or by compression, with hematoma being the most common cause. Sometimes the compartment syndrome can accompany the direct nerve injury, masking the signs of a nerve dysfunction. Case report: We present a patient with a false aneurysm of brachial artery, surrounding soft tissue hematoma with volar arm and forearm compartment syndrome and a simultaneous median nerve intraneural hematoma caused by a direct punction. The combination of injuries occurred after brachial artery access for endovascular treatment of bilateral iliac artery steno-occlusive disease. The patient was successfully treated by fasciotomy, arterial sutures, and nerve decompression via paraneuriotomy. Conclusions: Intraneural hematoma caused by direct puncture can be masked by concomitant compartment syndrome. Emphasis should be put on prevention, early recognition, and timely surgical treatment of intraneural hematomas, especially those accompanied by fascial compartment syndrome after endovascular interventions.

Acute forearm compartment syndrome postdialysis

Acute forearm compartment syndrome postdialysis

A Case of Forearm Compartment Syndrome Requiring Fasciotomy after Thrombectomy for Upper Limb Acute Artery Occlusion

A Case of Forearm Compartment Syndrome Requiring Fasciotomy after Thrombectomy for Upper Limb Acute Artery Occlusion

A case of subacute forearm compartment syndrome associated with transcondylar fracture of the distal humerus

A case of subacute forearm compartment syndrome associated with transcondylar fracture of the distal humerus

ALL SUGARS ARE NOT SWEET

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Extravasation of vesicants occurs when there is leakage from a vessel into the surrounding area, with the potential to cause tissue necrosis. Common vesicants include vasopressors, alkylating chemotherapeutic agents, hyper-osmolar or hypo-osmolar agents, and certain antibiotics (vancomycin). Dextrose, at concentrations greater than 10% (D10), is also considered a vesicant, with rates of extravasation from 50% dextrose (D50) varying between 10-30% (1). CASE PRESENTATION: A cachectic 48-year-old with a history of HIV and alcohol and IV drug use, presented with lethargy. Upon initial assessment, she had track marks on her arms and was only responsive to sternal rub, with her exam otherwise unremarkable. She briefly improved with intravenous naloxone but ultimately required intensive care unit admission following intubation for airway protection. The toxicology screen was positive for methadone, opioids, and alcohol. Initial labs revealed ALT of 118 units/L, AST of 94 units/L, hemoglobin of 9.5 g/dL, and albumin of 2.3 g/dL. She was started on thiamine, multivitamin, and folate supplements. Despite starting tube feeds, fingerstick (FS) glucose was consistently low, dropping to 35 mg/dL. She received 2 ampules of 50 mL (25 g) 50% dextrose through a 22-gauge antecubital peripheral IV line, with FS improving to 220 mg/dL after 10 minutes. Two hours later, extensive swelling and fluid-filled blisters were noted throughout the forearm and hand, with Doppler ultrasound revealing the absence of a radial pulse. Her arm was elevated, a cold compress was applied, and a local subcutaneous injection of hyaluronidase was administered. Compartment pressures remained within normal limits, and a repeat Doppler ultrasound after an hour showed reappearance of a right radial pulse. The patient's swelling and blisters improved over the next few days. DISCUSSION: To the best of our knowledge, there are only three published cases on D50 extravasation so far, where D50 was administered by initial paramedic responders, in the field, in an emergent setting (1,2,3). D10 has a similar median time to recovery and post-treatment Glasgow Coma Scale, but with a decreased risk of rebound hyperglycemia. In our case, as the hypoglycemia incident occurred in an intensive care unit, administering D10 would have been a better option, as frequent FS monitoring would have been possible to assess response. Fortunately, close monitoring allowed for early recognition, prompt treatment, and good outcome. CONCLUSIONS: Hypoglycemia is a frequently encountered complication in a critical care setting. This case emphasizes the importance of early detection and treatment when suspecting extravasation of D50 to prevent the development of serious complications. D10 is now emerging as a safer and equally effective alternative to D50 and could become the standard of care for hypoglycemia management. REFERENCE #1: Wiegand R, Brown J. Hyaluronidase for the management of dextrose extravasation. Am J Emerg Med. 2010 Feb;28(2):257.e1-2. doi: 10.1016/j.ajem.2009.06.010. PMID: 20159411. REFERENCE #2: Chinn M, Colella MR. Prehospital Dextrose Extravasation Causing Forearm Compartment Syndrome: A Case Report. Prehosp Emerg Care. 2017 Jan-Feb;21(1):79-82. doi: 10.1080/10903127.2016.1209263. Epub 2016 Sep 6. PMID: 27598324. REFERENCE #3: Lawson SL, Brady W, Mahmoud A. Identification of highly concentrated dextrose solution (50% dextrose) extravasation and treatment--a clinical report. Am J Emerg Med. 2013 May;31(5):886.e3-5. doi: 10.1016/j.ajem.2012.12.010. Epub 2013 Apr 18. PMID: 23602753. DISCLOSURES: No relevant relationships by Natasha Garg, source=Web Response No relevant relationships by Archana Pattupara, source=Web Response No relevant relationships by Adam Rothman, source=Web Response No relevant relationships by DISHANT SHAH, source=Web Response

Shoe-Lace Technique Hasten Delayed Primary Closure In Fasciotomy Wound For Forearm Compartment Syndrome

We report a case of acute compartment syndrome of the forearm in a 51-year-old man with open fracture distal third radius (Gustilo I). Decompressive fasciotomy was performed promptly. Complete progressive closure of the wound without split-thickness skin grafting was achieved using a shoe-lace technique: silastic vessel loop were interlaced held together with skin staplers placed at the edge of the fasciotomy wound and were then tightened daily. Delayed primary closure of the fasciotomy wound was performed after 8 days post fasciotomy with complete opposition of skin edges without tension. Shoelace closure is a good option for atraumatic fasciotomy wound closure with good cosmesis result.

Efficacy of Hyaluronidase in the Mannitol Extravasation Induced Compartment Syndrome-A Case Report and Review of Literature.

Mannitol is one of the indispensable drugs in neurosurgery to manage the raised intracranial pressure. Though considered safe, extravasation of mannitol into the tissues can cause considerable morbidity with the consequent development of compartment syndrome. We report a case of a 50-year-old female who developed forearm compartment syndrome due to mannitol extravasation after undergoing surgery for frontal glioma under general anaesthesia. The severe forearm compartment syndrome could be successfully managed without fasciotomy using hyaluronidase. We describe the pathophysiology, prevention and treatment strategies emphasising the use of hyaluronidase in the management of mannitol extravasation induced compartment syndrome.

A Study of the Prevalence, Origin, Insertion, and Innervation of the Gantzer muscle – A Variant Forearm Muscle

Gantzer muscles are variant muscles found within the flexor compartment of the forearm, located between the intermediate and deep muscular layers. The Gantzer muscle typically arises from the flexor digitorum superficialis muscle (FDS) and inserts either into the flexor digitorum profundus (FDP) or the flexor pollicis longus (FPL) muscle. In this 2020 summer research study, a total of 76 forearms from 38 prosected cadaveric specimens were dissected to investigate the prevalence, origin, insertion, and innervation of Gantzer muscles, when present. In total, Gantzer muscles were present in 68.4% (26/38) of the whole body donors and 60.5% (46/76) of the limbs. Of the 26 donors who possessed a Gantzer muscle, 20 (76.9%) specimens were documented as having this variant forearm muscle bilaterally. In addition, of the 46 forearms that possessed a Gantzer muscle, two limbs (4.3%) contained two Gantzer muscles within the same forearm. Concerning the specimens where the origin, or proximal attachment, of this accessory muscle were still intact within these prosections, 95% (38/40) of Gantzer muscles originated from the flexor digitorum superficialis. When the insertion, or distal attachments was not damaged in these previously dissected forearms, 80% (36/45) of Gantzer muscles inserted into the flexor pollicis longus, with the remainder inserting into the flexor digitorum profundus. In addition, within the intact forearms, 83.9% (25/31) of Gantzer muscles received innervation from the anterior interosseous nerve, with the remainder being innervated by the median nerve directly. Clinically, the presence of the Gantzer muscle can result in various compressive injuries, including impingement of the ulnar, common, or anterior interosseous arteries and neuropathy of the median or anterior interosseous nerve. Moreover, this variant muscle, which is more likely present than absent, should be considered during treatment and surgical management, especially during differential diagnoses for compartment syndrome of the anterior forearm. While only the 2020 results are presented, this study represents a small portion of a multi-year, expanded assessment of the prevalence, origin, insertion, and innervation of the Gantzer muscle.

Complete Fasciotomy Using a Radial Approach for Acute Forearm Compartment Syndrome: A New Technique.

Acute forearm compartment syndrome is damaging but rare. Early treatment reduces mid and long-term sequelae. The palmar compartment is most frequently involved but the dorsal compartment and mobile wad are also at risk. Multiple fasciotomies approaches have been described but are associated with long-term complications. In particular, wound management is important. Mini-invasive techniques are not available for acute forearm compartment syndrome. Acute leg release via a single approach has been developed and proven effective. Likewise, we present a lateral S-shaped approach for fasciotomies of the 3 forearm compartments in the case of acute forearm compartment syndrome.

Atypical Signs of Compartment Syndrome Caused by Pressure Injury in Forearm

Acute compartment syndrome (ACS) is a serious complication which is usually associated with fractures. Herein, we report a case of a patient with volar forearm compartment syndrome associated with closed muscle rupture without fracture of which the only external signs were superficial contact burns and pain. A 21-year-old man presented to our emergency department with painful swelling in the right forearm after being caught in a machine. Although he presented with pain, no open wound or fracture was seen. The patient was presumed to have a contusion and discharged. He presented with worsening pain the next day, when typical clinical features of ACS were observed and emergency fasciotomy was performed. Intraoperatively, ruptured flexor muscles were noted. Delayed presentation of forearm compartment syndrome accompanied by closed muscle rupture without fracture is extremely rare. Diagnosis is not easy because severe pain could be the only clue and can mask the signs of compartment syndrome, at risk of being missed.