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Timing of Presentation of Pediatric Compartment Syndrome and Its Microsurgical Implication: A Retrospective Review

Ziolkowski, Natalia I. B.Com., M.D., M.Sc.(c.); Zive, Leanne B.Sc.; Ho, Emily S. B.Sc., O.T.Reg., M.Ed.; Zuker, Ronald M. M.D.

Plastic and Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 663–670
doi: 10.1097/PRS.0000000000003075
Hand/Peripheral Nerve: Original Articles

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).

Toronto and London, Ontario, Canada

From the Division of Plastic and Reconstructive Surgery, University of Toronto; the Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children; and Western University.

Received for publication March 7, 2016; accepted August 4, 2016.

Presented at the 68th Annual Meeting of the Canadian Society of Plastic Surgeons, in Montreal, Quebec, Canada, June 24 through 28, 2014.

Disclosure: The authors have no conflicts of interest or financial disclosures. No funds were received for the preparation of this article.

Natalia I. Ziolkowski, B.Com., M.D., M.Sc.(c.), Division of Plastic and Reconstructive Surgery, Rotman/Stewart Building, 149 College Street, 5th Floor, Suite 508, Toronto, Ontario M5T 1P5, Canada,

©2017American Society of Plastic Surgeons