Fasciotomy is a fundamental aspect of mangled extremity management. Fasciotomy of the arm begins with a curvilinear approach over the volar forearm, with marking the incision extensions to be made distally to decompress the carpal tunnel and proximally to extend into the medial or lateral aspect of the arm/biceps. Approach to the deeper volar structures should include decompression of the mobile wad, medial flexor mass, and the deeper layers of digital flexors and pronators. Dorsal approach to the forearm is on a case by case basis. In the leg, the lateral approach is utilized to decompress anterior and lateral compartments, while the medial approaches allow release of the superficial and deep posterior compartments. Fasciotomy of the thigh is completed by rolling the vastus lateralis muscle anteriorly and opening the fascia posterior to the vastus to release the hamstrings, both done through a lateral thigh incision.
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