A new strategy to prevent the sequelae of severe Volkmann's ischemia

This paper compares two treatment strategies in severe Volkmann's ischemia that differ in the time of exploration and excision of the muscle infarct. Six patients underwent late exploration, more than 1.5 months after injury, and 5 patients underwent early exploration, within 3 weeks of injury. Functioning free-muscle transplantation was later performed on all 11 patients for functional restoration. Hand function was evaluated in each group to determine the degree of intrinsic muscle function and sensibility. In the late group, all patients had restricted hand function due to clawing, poor opposition, and sensory disturbance. In the early group, all patients had preserved metacarpophalangeal joint flexion and interphalangeal joint extension without clawing, and two had preserved opposition. Sensory disturbance was mild, and good hand function was achieved. In severe Volkmann's ischemia, we advocate early re-exploration with excision of the infarcted muscle within 3 weeks of injury or fasciotomy. Early exploration is technically simple, and neurolysis is not necessary. It preserves hand intrinsic function and sensation by removing the ischemic environment and preventing fibrosis that adds to nerve compression and nerve damage.