[Functional rehabilitation of the upper extremity after compartment syndrome]

In established compartment syndrome discrimination between the different forms of flexion contracture, i.e., manifest Volkmann's contracture and intrinsic contracture is necessary. A combination of both is also possible. Classification is essential for determination of whether reconstruction is indicated and what procedure should be selected. Shortening osteotomies of the ulna and radius are now of historical interest only, as is carpalectomy. Lengthening of the flexor tendons is indicated only in mild and localized limited contracture of only some of the long fingers, but there is a danger of possible further adhesions limiting the range of motion. Thus, cases of stage I and II according to Tsuge with persisting partial flexor motor function are treated mainly by muscle sliding operation (Scaglietti) combined with microsurgery for internal neurolysis of the median and ulnar nerves. The latter is anteriorly transposed. In cases of solitary intrinsic contracture we prefer the Littler release procedure. The most useful repair in advanced compartment syndrome, however, consists in free microsurgical tissue transfer. The non-contractile, degenerated scarred flexor muscle remnants are excised and substituted orthotopic by transfer of free, neurovascular muscle, with salvage of flexor motor function in the forearm.