The aims of this study were to document our experience with acute forearm compartment syndrome and to determine the risk factors for the need for split-thickness skin-grafting and the development of complications after fasciotomy.We identified from our trauma database all patients who underwent fasciotomy for an acute forearm compartment syndrome over a twenty-two-year period. Diagnosis was made with use of clinical signs in all patients, with compartment pressure monitoring used as a diagnostic adjunct in some patients. Outcome measures were the use of split-thickness skin grafts and the identification of complications following forearm fasciotomy.There were ninety patients in the study cohort, with a mean age of thirty-three years (range, thirteen to eighty-one years) and a significant male predominance (eighty-two patients; p < 0.001). A fracture of the radius or ulna, or both, was seen in sixty-two patients (69%), with soft-tissue injuries as the causative factor in twenty-eight (31%). The median time to fasciotomy was twelve hours (range, two to seventy-two hours). Risk factors for requiring split-thickness skin-grafting were younger age and a crush injury (p < 0.05 for both). Risk factors for the development of complications were a delay in fasciotomy of more than six hours (p = 0.018) and preoperative motor symptoms, which approached significance (p = 0.068).Forearm compartment syndrome requiring fasciotomy predominantly affects males and can occur following either a fracture or soft-tissue injury. Age is an important predictor of undergoing split-thickness skin-grafting for wound closure. Complications occur in a third of patients and are associated with an increasing time from injury to fasciotomy.