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Updated: Mar 7, 2026
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Timing of Presentation of Pediatric Compartment Syndrome and Its Microsurgical Implication: A Retrospective Review
Natalia I Ziolkowski1,2, Leanne Zive1,2, Emily S Ho1,2
1Toronto and London, Ontario, Canada.
Insights
Delayed decompression for pediatric forearm compartment syndrome significantly increases the risk of functional deficits. Early surgical intervention is crucial to prevent severe outcomes and the need for microsurgical reconstruction.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Microsurgery
Background:
- Pediatric forearm compartment syndrome can cause severe functional disability.
- Early decompression is linked to better outcomes, but the critical time window for preventing significant functional loss requiring microsurgery is unclear.
Purpose of the Study:
- To describe the rate of microsurgical reconstruction following pediatric forearm compartment syndrome in relation to the timing of presentation after injury.
Main Methods:
- A retrospective chart review of pediatric patients (2-16 years) with forearm compartment syndrome between 2000 and 2013.
- Data collected included demographics, injury cause, time to decompression, complications, and functional outcomes.
- Statistical analysis was performed to correlate time to decompression with outcomes.
Main Results:
- Thirty-five patients were included; 74% were male, and 66% had ulnar fractures.
- Fasciotomies were performed in 91% of cases; 6% had no decompression due to late presentation.
- Increased time to decompression was associated with long flexor tightness (17%) and gracilis muscle flap reconstruction (6%) for forearm muscle necrosis.
Conclusions:
- Presentation after 48 hours led to significant functional deficits.
- These deficits necessitated reconstructive surgery, such as gracilis muscle flap reconstruction, or long-term conservative management with serial casting.
Background:
Pediatric forearm compartment syndrome can lead to severe functional disability. Although it is known that earlier presentation with decompression leads to better outcomes, it is not known when presentation after injury leads to significant loss of function requiring microsurgical intervention. The authors describe the rate of microsurgical reconstruction after pediatric forearm compartment syndrome as related to timing of presentation.
Methods:
A retrospective chart review was conducted of pediatric patients with forearm compartment syndrome between January 1, 2000, and March 22, 2013, after a traumatic upper extremity injury. Demographic information, cause, time to decompression, complications, and functional outcome were recorded.
Results:
Thirty-five patients aged between 2 and 16 years (8.97 ± 4.12 years) met inclusion criteria. The majority (74 percent) were boys. The right upper extremity was predominantly involved (54 percent), with a predilection for ulnar fractures (66 percent). Fasciotomies were completed for 32 patients (91 percent). Two patients had no decompression (6 percent) because of late presentation. The average time to fasciotomy was less than 12 hours after injury in 16 patients (46 percent), 12 to 48 hours in 15 patients (43 percent), and greater than 48 hours in four patients (11 percent). Complications (63 percent) included nerve injury (40 percent), skin graft (37 percent), scar revision (11 percent), and long flexor tightness requiring serial casting (17 percent). Forearm muscle necrosis requiring microsurgical reconstructive surgery with a gracilis muscle flap occurred in two patients (6 percent). Increased time to decompression was statistically associated with long flexor tightness and gracilis reconstructive surgery.
Conclusion:
Presentation after 48 hours resulted in significant functional deficits requiring reconstructive surgery (gracilis muscle flap reconstruction) or long-term conservative management (serial casting).
