Name of the Procedure:

Decompression Fasciotomy, Forearm and/or Wrist, Flexor and Extensor Compartment; with Debridement of Nonviable Muscle and/or Nerve

Summary

A decompression fasciotomy for the forearm and/or wrist involves surgically releasing pressure in the flexor and extensor compartments, which are groups of muscles. If any muscle or nerve tissue is nonviable (dead or dying), it will also be removed during the procedure.

Purpose

This procedure addresses conditions where there is increased pressure within the muscle compartments of the forearm and/or wrist, typically due to injury or overuse. The goals are to relieve pressure, restore blood flow, and prevent or treat damage to muscles and nerves.

Indications

• Compartment syndrome (acute or chronic) causing severe pain, swelling, and impaired function.
• Trauma or injury leading to increased compartment pressure.
• Signs of ischemia (restricted blood flow), such as pallor or lack of pulse.
• Nonviable muscle or nerve tissue identified through clinical assessment or imaging.

Preparation

• Patients may need to fast for several hours prior to the procedure.
• Pre-operative blood work and imaging studies (e.g., MRI or CT scan) to assess the extent of tissue damage.
• Medication review and adjustments, especially anticoagulants (blood thinners).

Procedure Description

1. The patient is given anesthesia (general or regional, depending on the case).
2. A tourniquet may be applied to control bleeding.
3. The surgeon makes incisions in the skin overlying the affected compartments.
4. Fascial layers (connective tissue) are carefully cut to relieve pressure.
5. Any nonviable muscle or nerve tissue is debrided (removed).
6. The incisions may be left partially open or closed with sutures, depending on the degree of swelling.

Duration

The procedure typically takes 1 to 2 hours, depending on the severity and extent of the condition.

Setting

This procedure is performed in an operating room, usually in a hospital or surgical center.

Personnel

• Orthopedic or general surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection at the surgical site
• Bleeding and hematoma (blood collection)
• Nerve damage
• Incomplete relief of symptoms
• Scarring
• Chronic pain or loss of function if complications occur

Benefits

• Rapid relief from pain and swelling
• Restoration of normal blood flow
• Preservation of muscle and nerve function
• Prevention of permanent damage or loss of limb function

Recovery

• Post-operative wound care includes keeping the incision clean and dry.
• Pain management with prescribed medications.
• Physical therapy may be recommended to restore strength and function.
• Full recovery may take several weeks to months, with activity restrictions gradually lifting as healing progresses.
• Follow-up appointments for wound assessment and progress evaluation.

Alternatives

• Non-surgical treatments like rest, elevation, and ice, which may be effective for mild cases.
• Minimally invasive techniques (rarely, depending on severity and expertise available).
• Each alternative comes with its own set of pros and cons, often less effective in severe cases of compartment syndrome.

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel pain.
• Post-operatively, pain at the surgical site is common, managed through medications.
• Swelling and discomfort may persist for a few days to weeks.
• Gradual return to normal activities, with physical therapy support for optimal recovery.