Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XX: Wounds and Injuries of Peripheral Nerves
United States Department of Defense
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Occasionally missile wounds are associated with significant clot. If the clot is confined to a closed space incorporating neural elements, progressive loss of function can occur. Such closed spaces include the popliteal and knee spaces, the anterior compartment of the lower legs, and the buttocks, especially in the subgluteal space Similar dosed spaces in the upper extremity include the elbow and forearm, either beneath the lacertus fibrosis and pronator musculature, or the more distal forearm muscles. Immediate decompression and drainage are indicated for clots in these areas, while fasciotomy is indicated for extensive contusions which have resulted in a swollen, tight extremity. Nerve damage, muscle necrosis, fibrosis, and limb contracture can occur. A Volkinann's contracture, for example, can result in loss of median, radial, and sometimes ulnar function.
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