My husband is an electrician on a Naval destroyer. There was some kind of accident and he suffered an electrical burn. I don't know much but they say once he is stabilized, they will be doing surgery for a compartment syndrome of the hand. Please tell me what you can about this kind of injury.
Compartment syndrome describes a condition in which fluid (swelling or blood) builds up inside one or more of the individual compartments of the arm. An electrical burn is one of many ways this problem can develop.
The "compartments" are easier to understand if you think of each group of muscles and tendons as being surrounded by a protective sheath or lining of connective tissue called fascia. There are individual compartments on the front and back of the upper arm, forearm, hand, and fingers.
In each compartment, the fascia fits closely to the outer layer of the soft tissue it surrounds -- like a sleeve or envelope. The structures are lubricated with a glistening fluid that allows everything to slide and glide against each other. There isn't a lot of give or room for increased volume of fluid from swelling or bleeding from an injury.
When an injury occurs that leads to swelling, the increased pressure inside the sleeve or envelope cuts off blood supply to the muscles. The muscle cells start to necrose or die. Left untreated, this necrosis can progress to the point of gangrene. That sounds pretty extreme. The good news is that with early diagnosis and treatment, results are usually good.
Treatment may begin with just taking pressure off the arm whenever and however possible (e.g., loosening bandages, splint, or cast if that's the problem). Most of the time, early surgery is indicated.
The surgical procedure for this condition is called compartment decompression or fasciotomy. The surgeon slits open the skin and first layer of fascia called the epimysium. Once the upper layers of fascia have been released, the surgeon conducts a careful search of each compartment for any other areas of restriction.
The procedure does involve direct release of all layers of fascia involved and debridement (removal of any tissue that has died). In some cases, it may be necessary to release tight tissues from around nerves passing through the compartments.
The patient may need several surgeries to complete the decompression process. Skin grafts to cover the wound may be needed. Rehab to restore motion and function is the final step. We offer our best to you and your husband during this process and for your service to our country!
Fraser J. Leversedge, MD, et al. Compartment Syndrome of the Upper Extremity. In The Journal of Hand Surgery. March 2011. Vol. 36-A. No. 3. Pp. 544-560.
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