Single and Dual-Incision Fasciotomy of the Lower Leg.

Abstract

Compartment syndrome of the leg is an orthopaedic emergency and can be treated with single or dual-incision fasciotomy, allowing for necessary decompression of all four compartments. Place the patient supine with a bump underneath the ipsilateral buttock. An incision centered over the posterolateral aspect of the leg provides access to all four compartments of the leg. <i>Make longitudinal fascial incisions, approximately the length of the skin incision, in the superficial posterior, lateral, and then anterior compartments</i>. Using the lateral intermuscular septum as a guide to reach the posterolateral aspect of the fibula, release the fascial attachment of the deep posterior compartment from the fibula. After appropriate operative fixation and/or debridement of nonviable tissue, dress the wounds with a VAC device. Position the patient, administer antibiotics, and prepare and drape the limb as described in Step 1 for the single-incision technique. Make an incision centered over the anterolateral aspect of the leg to provide access to the anterior and lateral compartments of the leg. Make a longitudinal fascial incision in the anterior compartment anterior to the intermuscular septum and a separate longitudinal incision for decompression of the lateral compartment posterior to the intermuscular septum. Make an incision centered over the posteromedial aspect of the leg to provide access to the superficial and deep posterior compartments of the leg. Through the posteromedial skin incision, identify both the deep and the superficial posterior compartments and incise their fascia longitudinally for adequate decompression. Follow the same postoperative protocol as outlined in Step 5 for the single-incision technique. Both the single and the dual-incision techniques are effective for relieving elevated intracompartmental pressures to prevent myonecrosis.IndicationsContraindicationsPitfalls & Challenges.