The case described in our study is that of a 76-year-old woman with a history of hypertension, and rectal carcinoma treated 15 years ago with radiotherapy, surgery and chemotherapy, in complete remission at that time.
She received outpatient treatment with opioid analgesics, under follow-up in a Pain Unit, due to generalized arthrosis.
Last month of September 2013, the patient came to the emergency department with acute chest pain that was diagnosed with NSTEACS-Killip III, assessed by the Service of Radial stent placement Prasu
Two hours after admission to the Intensive Care Unit, the patient, in general stable conditions, begins with pain and hematoma formation in the volar aspect of the right forearm in relation to the area of catheterization puncture.
The patient is assessed by the Traumatology Service, and the physical findings found in the examination are the following:
- Pain, exacerbated by passive extension of the fingers (extremity of flexor muscles of the forearm).
- Pallor.
- Impossibility for detecting radial or ulnar pulse.
- Temperature decrease compared to the contralateral limb.
- Anesthesia and total paralysis of the affected limb.
Having established the clinical findings, a confirmatory diagnosis was made by measuring intracommental pressure with the Stryker® Intra-Compartmental pressure monitor system, obtaining a record of 42 mm Hg.
The diagnosis of acute mental illness syndrome in the right forearm is determined and urgent surgical treatment is proposed.
The surgical procedure was performed under balanced general anesthesia and airway control with laryngeal mask.
Antibiotic prophylaxis with 2 grams of intravenous Cefoline.
A skin incision was made on the midline of the volar face of the forearm, from the elbow flexion to the Kaplan line.
The subcutaneous cellular tissue was intensely infiltrated by hematoma.
A longitudinal fascia of the antequial fascia exposing the epitrochlear muscles of the forearm was performed, in addition to sectioning of the anterobrachial nerve by sectioning the median annular ligament.
No vascular lesions with signs of active arterial bleeding were observed.
Surgical closure was performed by covering the wound with sterile Niural impregnated sterile pads, and closing of circumstances was performed by means of vascular elastics (vessel loops) not compressing mesh and bandage.
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As soon as fasciotomy was performed, recovery of color and temperature of the affected limb as well as arterial pulse could be observed.
Three hours after surgery, the patient was reassessed, with a capillary refill of less than 2 seconds, mobility and distal sensitivity, and no pain symptoms.
Nine hours later, the patient presented absence of pain in the right forearm, with good distal vasculonervous condition.
