Congenital Volkmann ischaemic contracture: a case report and review

Abstract

Congenital Volkmann ischaemic contracture or neonatal compartment syndrome has rarely been discussed in the literature of dermatology. The condition often involves the upper extremity with cutaneous lesions, contractures and neuropathy. Because the lesions can be mistaken for other entities including necrotizing fasciitis, neonatal gangrene, congenital varicella, aplasia cutis congenita, amniotic band syndrome, subcutaneous fat necrosis and epidermolysis bullosa, dermatologists play a significant role in the diagnosis and, consequently, the treatment of the patient. We describe a premature newborn who had a unilateral, well-demarcated necrotic plaque with a central pallor at birth. The plaque extended circumferentially over the left forearm from the wrist to the elbow. Left wrist oedema, bullae over the fingers and flaccid paralysis at the wrist were also noted.

Volkmann Ischemic Contracture Due to Traditional Practice

“…The most important factor influencing the outcome of compartment syndrome is the presentation time; therefore, a low threshold for surgical exploration and fasciotomy is advocated when acute compartment syndrome is suspected on clinical grounds [9]. However, there was no correlation between the time from diagnosis to fasciotomy and residual deficits.…”

Neonatal Forearm Compartment Syndrome

“…From the etiologic point of view, Cham et al [2] reported cases of neonatal compartment syndromes with proposed causes including: oligohydramnios, death of a co-twin, gestational diabetes, excessive maternal weight gain, prematurity, etc. In the case he reported, unusual placement of the hand of the affected limb was suggested as a causative factor.…”

“…[2,6,7] Despite the requirement of early diagnosis and prompt intervention, the treatment option, whether surgical or medical, may vary. Therefore, a detailed work up with a team of plastic surgeons, neonatalogists and dermatologists is mandatory for the definitive diagnosis.…”

“…[1] Although commonly observed in adults with pre-existing etiologies like fractures, burns, crush injuries and external compressions, congenital form has been described, as well. [2,3] The importance of the newborn form lies on its similarity with other entities, where a definite diagnosis may be confusing. In additon, the urgency of the treatment, mainly fasciotomy, makes this subject more important.…”

Kompartmentsyndrom der oberen Extremität beim Neugeborenen

“…Tab. 3, [2,5,9]). Bereits aus der Namensgebung ist ersichtlich, dass Teilaspekte als Hauptsymptom fehlgedeutet werden.…”