Upper Extremity Compartment Syndrome — Diagnosis, Fasciotomy, and Limb Salvage

This episode reviews the core principles of upper extremity compartment syndrome, focusing on anatomy, pathophysiology, diagnosis, and surgical decompression.Topics include the volar, dorsal, and mobile wad compartments of the forearm, the deep volar danger zone containing FDP, FPL, and pronator quadratus, and the 10 compartments of the hand. The episode also explains the pressure-gradient physiology of compartment syndrome, including venous collapse, edema, ischemia, sodium-potassium pump failure, and the critical 6-hour window for muscle salvage.Clinical diagnosis is reviewed through the limitations of the classic Five Ps, with emphasis on pain out of proportion, pain with passive stretch, paresthesia as an early nerve finding, and why pulses can remain intact despite limb-threatening ischemia. Pressure measurement is discussed using delta pressure, with concern when diastolic pressure minus compartment pressure is less than 30 mmHg.Surgical management includes immediate removal of external compression, keeping the limb at heart level, and decompression through volar lazy-S forearm fasciotomy, carpal tunnel release, deep volar compartment release, dorsal compartment release, mobile wad assessment, and hand fasciotomies through four standard incisions. Postoperative principles include leaving wounds open, VAC therapy, second-look debridement, delayed closure or skin grafting, rhabdomyolysis monitoring, and prevention of Volkmann ischemic contracture. Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordsupper extremity compartment syndrome, forearm compartment syndrome, hand compartment syndrome, fasciotomy, volar compartment, dorsal compartment, mobile wad, deep volar compartment, FDP ischemia, FPL ischemia, 10 hand compartments, five Ps compartment syndrome, pain with passive stretch, delta pressure, Stryker pressure measurement, Volkmann ischemic contracture, carpal tunnel release fasciotomy, lazy S incision, hand fasciotomy, Cleland ligament, Grayson ligament, rhabdomyolysis, myoglobinuria, wound VAC, delayed primary closure