Forearm Compartment Syndrome Following a Thermal-Crush Injury Treated With a Dorsal Ulnar Artery Flap: A Case Report.

Compartment syndrome (CS) is a condition that requires immediate attention; if diagnosis is delayed and treatment is not provided promptly, it can lead to complications resulting in permanent functional disability or limb loss. As the name suggests, once a muscle compartment is affected by an injury, this syndrome may develop, manifesting as progressive inflammation and edema, leading to reduced blood flow to the limb. Diagnosis is primarily clinical, based on signs of impaired perfusion. Fasciotomy is the treatment of choice, helping to prevent amputations when performed in a timely manner. However, it is associated with significant complications, as closing the fasciotomy incision can pose a considerable surgical challenge; therefore, post-fasciotomy procedures are just as important as the decompression procedure itself. In this context, the use of grafts and delayed wound closure are frequent therapeutic options. When these measures fail, the use of flaps is feasible, although there is limited literature on their use following fasciotomy. The purpose of this article is to present the case of a patient whose forearm became trapped in a dryer, resulting in an injury from a combined crush and thermal mechanism. Despite multiple procedures, coverage of the open wound was not achieved, so the use of flaps was considered. The radial forearm flap sacrifices one of the main arteries of the hand, the interosseous flap can be difficult to perform, and the inguinal flap requires prolonged immobilization and two procedures. Therefore, we opted for the dorsal ulnar flap to close the post-fasciotomy wound, which is quick and easy to perform, relies on a continuous blood vessel without compromising the major arteries of the hand, allows for early mobilization, and enabled us to achieve adequate coverage of the wound with tendon exposure involving the wrist and hand. We conclude that the dorsal ulnar flap is a reliable and effective option for wound coverage following fasciotomy in forearm CS.