Brown Ciara A, Menon Ambika, Jones Hannah E, Ghareeb Paul A
From the Division of Plastic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Emory University School of Medicine, Atlanta, GA.
Plast Reconstr Surg Glob Open. 2025 Aug 4;13(8):e6994. doi: 10.1097/GOX.0000000000006994. eCollection 2025 Aug.
Forearm acute compartment syndrome (ACS) requires emergent fasciotomy to avoid irreversible sequelae. Although trauma is the most common cause of ACS, atraumatic causes require a high index of suspicion. We evaluated scenarios and outcomes of forearm fasciotomies to better understand this rare but critical diagnosis.
All patients who underwent forearm fasciotomy at 2 institutions were retrospectively reviewed from 2007 to 2022. Clinical outcomes including mortality, secondary surgery, and complications were analyzed.
Eighty-eight forearm fasciotomies were performed during the study period. The most common clinical scenarios for fasciotomy were trauma (48%) and arterial catheterization (13.6%). Forty-two percent of patients underwent skin closure at the index operation without complication. The reoperation rate following fasciotomy was 55% (n = 48), all of which occurred in the secondary closure cohort. The overall mortality rate after forearm fasciotomy was 13.7% (23% in atraumatic versus 8% in traumatic causes, = 0.09). Atraumatic causes were found to have significantly increased underlying medical comorbidities compared to traumatic causes ( < 0.05). Increased lactate and potassium were associated with mortality across all groups.
Forearm ACS should be acknowledged as a potential risk of arterial catheterization procedures. The risk of mortality after fasciotomy is high, and forearm ACS in highly comorbid individuals may be considered a surrogate marker of underlying medical disease severity. The risk of subsequent mortality in these cases should be used to counsel patients. Primary closure of fasciotomy sites in appropriately selected cases can safely reduce the number of secondary procedures.
前臂急性骨筋膜室综合征（ACS）需要紧急进行筋膜切开术以避免不可逆转的后遗症。虽然创伤是ACS最常见的原因，但非创伤性原因需要高度怀疑。我们评估了前臂筋膜切开术的情况和结果，以更好地理解这种罕见但关键的诊断。
对2007年至2022年在2家机构接受前臂筋膜切开术的所有患者进行回顾性研究。分析包括死亡率、二次手术和并发症在内的临床结果。
在研究期间共进行了88例前臂筋膜切开术。筋膜切开术最常见的临床情况是创伤（48%）和动脉插管（13.6%）。42%的患者在初次手术时进行了皮肤缝合，无并发症。筋膜切开术后的再次手术率为55%（n = 48），所有再次手术均发生在二期缝合组。前臂筋膜切开术后的总体死亡率为13.7%（非创伤性原因导致的死亡率为23%，创伤性原因导致的死亡率为8%，P = 0.09）。与创伤性原因相比，非创伤性原因的基础医疗合并症明显增加（P < 0.05）。所有组中，乳酸和钾升高与死亡率相关。
应认识到前臂ACS是动脉插管操作的潜在风险。筋膜切开术后的死亡风险很高，高度合并症患者的前臂ACS可能被视为基础医疗疾病严重程度的替代指标。这些病例后续的死亡风险应用于向患者提供咨询。在适当选择的病例中，对筋膜切开部位进行一期缝合可安全减少二次手术次数。
