Fasciotomy: Upper Extremity Fasciotomy: Upper Extremity David Ray Velez, MD Table of Contents Upper Arm FasciotomyForearm FasciotomyHand Fasciotomy See Also:*See Compartment Syndrome*See Fasciotomy Upper Arm Fasciotomy Upper Arm Compartments (x3) Anterior (Flexors) Posterior (Extensors) Deltoid Upper Arm Fasciotomy Technique Single Lateral Incision from the Deltoid Insertion to the Lateral Epicondyle Incise the Anterior Fascia to Release the Anterior Compartment Incise the Posterior Fascia to Release the Posterior Compartment Upper Arm Compartments Upper Arm Fasciotomy Forearm Fasciotomy Forearm Compartments (x3) Volar (Flexors) Dorsal (Extensors) Lateral/Mobile Wad (Brachioradialis and Extensor Carpi Radialis Muscles) The Volar Compartment is the Most Commonly Affected The Lateral Compartment (Mobile Wad) is Rarely Affected Forearm Fasciotomy Technique Volar (“Henry”) Incision: Start Proximal Over the Medial Epicondyle ‘S’ Curve Laterally Over Antecubital Fossa and Extended Back Medially Over the Forearm Finish Over the Palmar Crease Incise the Fascia of the Volar and Lateral Compartments to Release Each May Consider a Carpal Tunnel Release to Decompress the Median Nerve Dorsal Incision: Single Vertical Incision Incise the Dorsal Fascia to Release the Dorsal Compartment Forearm Compartments Forearm Fasciotomy Hand Fasciotomy Hand Compartments (x10) Thenar Hypothenar Dorsal Interosseous x4 Volar Interosseous x3 Adductor Pollicis Hand Fasciotomy Technique Two Longitudinal Dorsal Incisions Over 2nd/4th Metacarpals Longitudinal Incision Over Medial Aspect of 5th Metacarpal Longitudinal Incision Over Lateral Aspect of 1st Metacarpal Tailor Fasciotomies to Symptoms All Should Also Have Carpal Tunnel Release Hand Compartments 1 Hand Fasciotomy References Reichman EF. Compartment Syndrome of the Hand: A Little Thought about Diagnosis. Case Rep Emerg Med. 2016;2016:2907067. (License: CC BY-4.0)