Name:
20 Fasciotomy Upper Extremity
Description:
20 Fasciotomy Upper Extremity
Thumbnail URL:
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Duration:
T00H06M15S
Embed URL:
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Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/ea8f0f44-1499-4ce4-9bb7-3f9c774e1fd4/2020Fasciotomy20Upper20Extremity.mov?sv=2019-02-02&sr=c&sig=SL1uo7h3UKRsK7kbE1WaO89kkng7ZyjX2IYjYBgPUK4%3D&st=2024-05-03T06%3A01%3A44Z&se=2024-05-03T08%3A06%3A44Z&sp=r
Upload Date:
2022-03-03T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
In this video we will be discussing the proper techniques to perform an upper extremity fasciotomy.
Segment:1 Objectives.
We will start by discussing the relevant anatomy, the instruments and positioning, the techniques and exposure and, finally, the tips and pitfalls of this procedure. The upper arm consists of two compartments
Segment:2 Anatomy.
the anterior and posterior compartments which extend from the deltoid insertion to the lateral epicondyle on the lateral aspect of the upper arm.
The anterior compartment consists of the biceps, brachialis and cortical brachialis muscles which are innervated by the musculocutaneous nerve, while the posterior compartment consists of the triceps muscle innervated by the radial nerve. The volar or anterior aspect of the forearm contains the flexor compartments, extending from the medial bicipital groove, proximally, along the anterior aspect of the forearm to the carpal tunnel and palmar fascia, to the thenar eminence distally.
The flexor compartment consists of eight muscles, the mobile wad and the fascia overlying each muscle valley innervated by the radial and ulnar nerves and supplied by the ulnar artery. At the level of the wrist, the Flexor Retinaculum, or carpal tunnel, is encountered, which must also be decompressed during this procedure. Deep to the Flexor Retinaculum lies the median nerve. During carpal tunnel release, great care must be taken to preserve this nerve.
The dorsal or posterior aspect of the forearm contains the extensor compartment, extending from the Mobile Wad to the wrist. These muscles are innervated by the radial nerve and supplied by the radial artery. Like the Flexor compartment, the extensor compartment is made up of the fascia of the individual extensor muscles. The hand contains ten separate fascia compartments, including the carpal tunnel, previously demonstrated.
The dorsal fascial compartments of the hand are located within the interosseous spaces between the metacarpal bones. On either side of the metacarpals, the interosseous muscles and their overlying fascia make up the compartments of the dorsal hand.
Segment:3 Instruments and Positioning.
The patient should be positioned supine with the arm on an extremity table. The preparation should include the entirety of the upper extremity, from the shoulder to the finger tips.
The standard orthopedic tray, self-retaining retractors and a compartment pressure monitoring system are necessary instruments. For decompression of the upper arm a single skin incision is made on the lateral aspect of the arm, extending from the insertion of the Deltoid to the lateral epicondyle. The incision is then carried through the subcutaneous fat, exposing the underlying fascia.
Once the fascia is exposed, the fascia overlying the anterior and posterior compartments of the arm is incised along the length of the incision. Visualization of the underlying muscle, as well as identification of the intermuscular septum will confirm decompression of the upper arm. Fasciotomy of the interior or volar aspect of the forearm utilizes a "lazy S" type incision beginning just proximal to the antecubital fossa on the medial aspect of the forearm in the groove between the biceps and triceps muscles.
As the incision is carried distally, it generally curves laterally along the proximal aspect and curves medially at the distal aspect. As the incision is extended over the carpal tunnel to the medial border of the thenar eminence, it crosses in an oblique to transverse-type fashion. The incision is then carried through the subcutaneous fat to expose the underlying fascia. The fascia overlying the individual muscles within the flexor compartment are then decompressed by incising the fascia, along the length of the muscle valleys.
At the level of the wrist the flexor retinaculum, or carpal tunnel, is encountered. This is a tough fascial structure, which must be incised in order to perform a complete fasciotomy of the forearm and hand. During release of the carpal tunnel, great care must be taken to avoid injury to the underlying median nerve. Fasciotomy of the dorsal aspect of the forearm is performed via a single incision extending from the wrist to the elbow between the mobile wad and the extensor digitorum muscle valleys.
Once the fascia is encountered, the fascia overlying the muscles of the extensor compartment are incised along the length of the muscles, thus decompressing the extensor compartment. Fasciotomy of the hand is accomplished by decompression of the carpal tunnel, as previously demonstrated, and through two incisions on the dorsal aspect of the hand. The incisions are made over the second and fourth metalcarpal inner spaces. The extensor tendons are retracted and the fascia on either side of the metalcarpal and extensor tendons is incised exposing the interosseous muscles, and thus completing the fasciotomy of the hand.
Segment:4 Tips and Pitfalls.
Delayed diagnosis is the most common problem in management of compartment syndrome, with a high index of suspicion compartment pressures should be measured. The flexor retinaculum is a very broad and thick ligament. Adequate decompression requires full division of the ligament onto the thenar eminence. The median nerve lies immediately deep to the flexor retinaculum, and great care must be taken to preserve this nerve during carpal tunnel release.
Thank you.