Fasciotomy to Save a Limb with Compartment Syndrome

In December, I operated on a little girl’s forearm. She had developed compartment syndrome after falling and injuring her arm. The child’s family assumed she had broken her arm and brought her to the bonesetter who wrapped the arm tightly.  After 2 days, it became apparent that the child’s arm was severely injured and she was brought to the hospital. The arm was swollen and tense, discolored and numb with no pulses.

The muscles in the arms and legs are encased in thick connective tissue compartments (called fascia).  When the muscles become swollen within this compartment, the pressure can compress the nerves, blood vessels and even the muscle itself to the point that the tissue begins to die.

** WARNING: GRAPHIC IMAGES **

We quickly brought her to the operating room to do a fasciotomy.  I made an incision along the length of the forearm in order to open the thickened skin and fascia to allow the bulging muscles to have room to expand. It resembled a can of rolls as it is popped opened. The skin was  left open until the swelling subsided and her had was splinted in a functional position.

She remained in the hospital a couple weeks, until the wound became more manageable and less painful during the daily dressing changes. The family opted against skin grafts to close the wound, and allowed the wound to heal by scar formation.

The little girl has regained minimal function of the hand at this time, but not much. Only time will tell if the nerves regenerate more than they have. The mother has been exercising and stretching her daughter’s fingers to keep them from getting contractures or becoming too stiff.

At the end of the patient’s hospitalization, KJ joined me one day to greet her and to play. Only one month apart in age, they had a blast together.

A couple months later, we saw the girl in her hometown at a church we were visiting. Her wound was completely closed. I watched as she used her hand to stabilize a paper on which she was drawing, but could see that the fingers and hand were not working fully.

Pray that she will continue to regain function of her hand and that she and her family will continue to seek Jesus.

Comments