Forearm compartment pressures: an in vitro analysis of open and endoscopic assisted fasciotomy

Pressure reduction for standard open fasciotomy and a novel endoscopic fascial release were compared in experimental conditions of elevated forearm compartment pressures by continuously monitoring intracompartmental pressures in 22 cadaver forearms. Both methods were effective in diminishing tissue pressures. Intracompartmental pressures were reduced to significantly lower levels following open versus endoscopic assisted fasciotomy (2.9 mm Hg vs. 13.2 mm Hg). In the endoscopic group a statistically significant second decrease in pressure was observed after dermatomy, reducing intracompartmental tissue pressures from 13.2 mm Hg to 3.1 mm Hg. The results of this study suggest that endoscopic assisted fasciotomy can reduce elevated tissue pressures, confirming previous findings that fascial release is of primary importance in decreasing intracompartmental tissue pressures. Open fasciotomy, however, gave significantly greater decompression than the endoscopic technique, a difference that may be even more substantial in the clinical setting due to several limiting factors of this in vitro model. Our results also suggest that immediate skin closure following fasciotomy increased tissue pressure and therefore should be avoided.