Upper Extremity Fasciotomy After Arterial Embolization

Compartment syndrome is characterized by an increase in intercompartmental pressure to the point of interruption of tissue microcirculation and ultimately tissue necrosis. While compartment syndrome in the setting of arterial embolization is a relatively rare phenomenon, knowledge of the diagnosis and treatment of this syndrome is required for the surgeon who deals with arterial thoracic outlet syndrome (TOS). Diagnosis is made via clinical exam and history. Measurement of intercompartmental pressures can help guide diagnosis, especially in those patients in whom obtaining an accurate history and physical exam is challenging, such as the obtunded, intubated, or pediatric patient. Treatment is surgical decompression of all involved compartments. In the forearm, a volar skin incision will give access to both volar compartments and often allow for decompression of the mobile wad as well. Post-operative care is supportive for open wounds with delayed closure, either primary closure or skin graft, to allow for resolution of edema. Delay in diagnosis and operative intervention greater than 6 h following the initiation of compartment syndrome is associated with a higher complication rate. Any suspicion of compartment syndrome should be taken very seriously, the patient should be immediately examined and monitored if necessary.