Compartmentotomy and decompression

Forearm ischemic contracture is a sequela of acute forearm compartment syndrome. If the correct treatment can be given in the early stage, the occurrence of ischemic contracture can be greatly alleviated or avoided. Early and reasonable treatment comes from early diagnosis. The following conditions may be considered for the presence or presence of acute forearm acute compartment syndrome: elbow, arm fracture, dislocation or sprain, etc., swelling of the affected arm, pain Finger flexion and extension function is limited; when the finger is passively stretched or flexed, it causes severe pain on the volar or dorsal side of the forearm; there is tenderness in the longitudinal extension of the affected flexor and flexor muscles, skin flushing, freckle, and tension blisters The fingertips are cold and cyanotic, and they feel dull or lost. The intraventricular pressure between the fascia exceeds 30-60 mmHg, and the radial artery beats normally, weakening or disappearing. Especially after the above-mentioned causes of injury, when the fingers are passively flexed and flexed, if the forearm has a severe pain on the volar or dorsal side, the forearm is progressively swollen, the tension is high, and the pressure is not depressed, which is the main basis for making a correct diagnosis at an early stage. For the forearm acute fascial compartment syndrome, in addition to the general treatment, timely fascial compartment incision, adequate decompression, is an indispensable part of early treatment, but also the only prevention of late complications of ischemic contracture A reliable method. Treatment of diseases: forearm artery injury Indication Fascial compartment decompression is suitable for: 1. The fascial compartment is highly swollen, tender, and severely painful. The flexion of the wrist is weak, the fingers are cold, the cyanosis, the finger is in the flexion position, and the active or passive flexion refers to the abdomen. . 2, the affected limbs are progressively swollen, the muscles and abdomen are hard, and the limbs have a sleeve-like feeling that decreases or disappears. The radial artery beats weakened or disappeared. Sometimes the brachial artery beats normally, but the muscles are also obviously ischemic. Because the interventricular tension between the forearm flexor fascia is normal, the small arteries of the main arteries of the forearm are open to maintain muscle blood supply. When the current arm is swollen and the intrafascial pressure increases to a certain extent, although the main arteries still have blood flow, the small muscles of the nutrient muscles are closed, and the muscles are in a severe ischemic state. Therefore, it is important not to have a pulsation of the radial artery, but ignore other clinical manifestations and delay the timing of surgery. 3, the intrafascial room pressure > 40mmHg, or tissue pressure rise to a level below the diastolic pressure of 10 ~ 30mmHg. Preoperative preparation 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 the indoor pressure measuring device, and measure the pressure between the fascia and make a record. Surgical procedure 1, forearm volar fascia interventricular incision (1) Incision: A single incision decompression method is often used, and a modified Gelberman surgical incision is commonly used. The skin incision starts from the outside of the elbow fossa outside the biceps tendon, obliquely across the elbow fossa, to the anterior and posterior superior forehead of the forearm and the flexor muscle, and then gradually turns to the outside, reaching the midline of the mid-third of the forearm junction. Then continue straight down, extending inside the palmar long muscles, reaching the lateral wrist stripes, then twisting and extending to the middle of the palm. (2) On the designed incision line, the skin, subcutaneous tissue and deep fascia are cut in full length, and the carpal tunnel is opened at the same time. The subcutaneous superficial vein should be avoided as much as possible. The biceps aponeurosis was cut obliquely to remove the hematoma. At this time, it can be seen that the superficial muscle of gray ischemia immediately resumes blood supply, and reactive hyperemia occurs. Due to the high tension between the fascia, the muscle can bulge through the incision. If the deep muscles are still gray and white, the muscles of these muscles should be cut longitudinally to restore the blood of the deep muscles. When cutting the epithelium, be careful not to damage the branches of the nerve that pass through the epicardium and enter the muscle. If the blood supply to the muscles of the fascia and the epicardium is still not significantly improved, the radial artery should be explored immediately, and the radial artery is exposed on the elbow in the deep aponeurosis of the biceps and the biceps and the medial side of the diaphragm. If the radial artery is paralyzed, contused, partially broken or completely broken due to compression at the fracture end or direct stab wound to the blood vessel, the fracture should be first reset, internal fixation, and then appropriately treated according to different conditions. If the median nerve, the ulnar nerve have sensory disturbances and the internal tendon of the hand, the compression should be fully relieved around, that is, the aponeurosis of the biceps and the proximal edge of the pronated circumflex muscle in the elbow and the proximal edge of the superficial flexor And wrist, ruler inside. If necessary, the epicardium is dissected and the nerve is released to relieve the pressure. Treatment of local fractures, dislocations or hemostasis. The muscle space is filled with a Vaseline gauze strip, or a rubber tube or a silicone tube for drainage. The incision was not sutured, covered with a sterile dressing and gently wrapped. 2, forearm dorsal fascia compartment incision (1) Incision: starting from the distal side of the upper upper jaw 2cm, the straight line extends 7-12cm to the midline of the wrist. (2) Incision of the skin, subcutaneous tissue and deep fascia along the designed incision line, respectively, reaching the muscles of the total extensor, the supinator, and the wrist. Check the fracture, dislocation, bleeding, and compression factors in this area and deal with them accordingly. If the back of the hand is severely swollen and the interosseous muscle pressure is still high, the dorsal incision of the forearm can be extended to the ulnar side of the tiger's mouth and the fourth metacarpal, respectively, and the deep fascia is cut. The pressure in each chamber was measured. If the pressure has been completely reduced, then the wound is drained without slitting. (3) Cover the sterile gauze bandage. Gypsum or splint secures the elbow, forearm and wrist.

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