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

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. 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. 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. 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.