A cadaver study into the number of fasciotomies required to decompress the anterior compartment in forearm compartment syndrome.

PURPOSE: There is no typical approach for decompression of forearm compartment syndrome, due to contradictory considerations regarding the characteristics of forearm anterior compartment deep fascia. The main purpose of this study was to determine how many fasciae should be opened to fully decompress the forearm anterior compartment. Further, the compliance of the deep anterior compartment was also investigated, to strengthen our results.

METHODS: An experimental study of a laboratory model of acute forearm compartment syndrome was performed. A deep forearm injection of egg white was undertaken to create an acute forearm compartment syndrome in sixteen non-embalmed human forearms from six male and two female donors. The pressure in the superficial and deep anterior compartments was recorded four times, both before and after each fasciotomy and the compliance of the deep anterior compartment was calculated for each step.

RESULTS: The first incision of the superficial lamina of the deep fascia was not sufficient to decrease the elevated compartment pressure in the superficial and deep anterior compartments. Whereas the pressures decreased to near-baseline levels, following the fasciotomy of the intermuscular septum observed posterior to the flexor carpi radialis. The last incision of the deep lamina of the deep anterior fascia had no noticeable impact. These observations supported the hypothesis of high compliance of the deep anterior compartment.

CONCLUSION: Two successive incisions were necessary to decompress the anterior compartment: the incision of the superficial lamina of the deep fascia and the incision of the intermuscular septum.