gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Acute Compartment Syndrome of Upper Limb Requiring Emergency Wide Range Fasciotomy Caused by Suction Injury. A Case Report

Meeting Abstract

  • presenting/speaker Masataka Shibayama - Chiba Medical Center, Department of Orthopaedic Surgery, Chiba, Japan
  • Jiro Hirayama - Chiba Medical Center, Department of Orthopaedic Surgery, Chiba, Japan
  • Koji Fujita - Chiba Medical Center, Department of Orthopaedic Surgery, Chiba, Japan
  • Hironori Yamazaki - Chiba Medical Center, Department of Orthopaedic Surgery, Chiba, Japan
  • Tsuguo Morikawa - Chiba Medical Center, Department of Orthopaedic Surgery, Chiba, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-381

doi: 10.3205/19ifssh0097, urn:nbn:de:0183-19ifssh00971

Published: February 6, 2020

© 2020 Shibayama et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Acute compartment syndrome due to absorbing by vacuum hose is a rare injury that requires immediate diagnosis and surgical resolution. We report a case of acute compartment syndrome in the upper limb from shoulder to hand requiring emergency wide range fasciotomy caused by suction injury.

Materials and Methods: A right-handed 24-year-old man was injured by suctioning his whole upper limb about 30 seconds by the hose of vacuum car which treat factory waste. Initially, he only felt mild pain and observed by himself at home. About 12 hours after the injury, he came to our hospital literally "Walk-in". At the first medical examination revealed diffuse swelling and hardening muscles from shoulder to hand, but there was no rest severe pain, paleness, pulselessness, paresthesia, nor paralysis. He felt disproportionate pain on passive extension of the deltoid, biceps, triceps, flexor and extensor muscles of forearm except intrinsic muscles of hand. From the above, he was diagnosed with acute compartment syndrome of upper limb from shoulder to forearm, and we decided to perform an emergency wide range fasciotomy under general anesthesia. We measured intra-compartmental pressure after anesthesia using an arterial line transducer. The intra-compartmental pressure of each muscles rose from 30 to 70 mmHg, so we performed fasciotomy by the Henry approach extended from the wrist to volar upper arm and independent dorsal upper arm approach. After the procedure, the intra-compartmental pressure of each muscles fell to normal level, and we used shoelace technique with elastic vessel loop. After one week, the swelling of whole upper limb went down, we re-sutured the wound completely.

Results: After eight months, he healed without any disfunction of shoulder, elbow, forearm, hand, and finger.

Conclusion: Acute compartment syndrome of upper limb caused by suction injury is rare, and in some case, the pain is so mild as to pass unnoticed at the initial visit. If the compartment syndrome is missed, it will result in very serious sequela. Therefore, in such case, even if the injury looks light, we need to perform fasciotomy without hesitation.