Trans-Ulnar Single Incision Fasciotomy for Decompression of Forearm Compartment Syndrome: A Cadaveric Study.

Objectives: Acute compartment syndrome (ACS) is a medical emergency that requires timely intervention, and delays in treatment can lead to severe complications such as nerve injury, muscle necrosis, amputation, and even death. Definitive treatment of ACS requires a fasciotomy. Currently, there is no consensus on the best approach for a forearm fasciotomy; compartment release is most commonly done through volar or combined volar and dorsal incisions. A trans-ulnar single incision approach has been demonstrated to be effective in a case report. This study investigates if a trans-ulnar single incision decompresses both deep volar and dorsal forearm compartments to less than 30 mmHg in a cadaveric model of ACS.

Methods: Ten fresh, frozen cadaveric upper extremities were injected with egg whites and compartment pressures were measured to determine successful simulation of ACS. A single trans-ulnar incision was made between the Flexor Carpi Ulnaris (FCU) and Extensor Carpi Ulnaris (ECU), extending from 4 to 5 cm (2″) proximal to the ulnar styloid to 6 to 8 cm (3″) distal to the olecranon. After blunt dissection to release the compartments, pressures were measured to confirm decompression.

Results: ACS was successfully simulated in all upper extremities to above 30 mmHg. The mean volume of saline injected to simulate local anesthetic was 38.0 ± 4.2 mL. The mean operative time was 10.1 min. The mean compartment readings 1-min post-fasciotomy were 7.1 ± 3.0 mmHg for the deep volar compartment and 9.4 ± 5.6 mmHg for the dorsal compartment. All fasciotomies reduced deep volar and dorsal compartment pressures below the clinical threshold of 30 mmHg, with significant differences between pre- and post-fasciotomy pressures.

Conclusions: All 10 fasciotomies successfully reduced deep volar and dorsal compartment pressures to below the clinical threshold of 30 mmHg, demonstrating the success of the trans-ulnar single incision fasciotomy to decompress compartment syndrome in cadaveric forearms.