Keerat Singh1, Jesse E Bible1, Hassan R Mir1. 1. Vanderbilt Orthopaedic Institute, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232. E-mail address for H.R. Mir: hassan.mir@vanderbilt.edu.
Abstract
INTRODUCTION: 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. STEP 1 SINGLE-INCISION TECHNIQUE POSITION THE PATIENT: Place the patient supine with a bump underneath the ipsilateral buttock. STEP 2 SINGLE-INCISION TECHNIQUE MAKE THE SKIN INCISION: An incision centered over the posterolateral aspect of the leg provides access to all four compartments of the leg. STEP 3 SINGLE-INCISION TECHNIQUE DECOMPRESS THE SUPERFICIAL POSTERIOR LATERAL AND ANTERIOR COMPARTMENTS: Make longitudinal fascial incisions, approximately the length of the skin incision, in the superficial posterior, lateral, and then anterior compartments. STEP 4 SINGLE-INCISION TECHNIQUE DECOMPRESS THE DEEP POSTERIOR COMPARTMENT: 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. STEP 5 SINGLE-INCISION TECHNIQUE POSTOPERATIVE PROTOCOL: After appropriate operative fixation and/or debridement of nonviable tissue, dress the wounds with a VAC device. STEP 1 DUAL-INCISION TECHNIQUE POSITION THE PATIENT: Position the patient, administer antibiotics, and prepare and drape the limb as described in Step 1 for the single-incision technique. STEP 2 DUAL-INCISION TECHNIQUE MAKE THE ANTEROLATERAL SKIN INCISION: Make an incision centered over the anterolateral aspect of the leg to provide access to the anterior and lateral compartments of the leg. STEP 3 DUAL-INCISION TECHNIQUE DECOMPRESS THE ANTERIOR AND LATERAL COMPARTMENTS: 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. STEP 4 DUAL-INCISION TECHNIQUE MAKE THE POSTEROMEDIAL SKIN INCISION: Make an incision centered over the posteromedial aspect of the leg to provide access to the superficial and deep posterior compartments of the leg. STEP 5 DUAL-INCISION TECHNIQUE DECOMPRESS THE SUPERFICIAL AND DEEP POSTERIOR COMPARTMENTS: Through the posteromedial skin incision, identify both the deep and the superficial posterior compartments and incise their fascia longitudinally for adequate decompression. STEP 6 DUAL-INCISION TECHNIQUE POSTOPERATIVE PROTOCOL: Follow the same postoperative protocol as outlined in Step 5 for the single-incision technique. RESULTS: Both the single and the dual-incision techniques are effective for relieving elevated intracompartmental pressures to prevent myonecrosis.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: 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. STEP 1 SINGLE-INCISION TECHNIQUE POSITION THE PATIENT: Place the patient supine with a bump underneath the ipsilateral buttock. STEP 2 SINGLE-INCISION TECHNIQUE MAKE THE SKIN INCISION: An incision centered over the posterolateral aspect of the leg provides access to all four compartments of the leg. STEP 3 SINGLE-INCISION TECHNIQUE DECOMPRESS THE SUPERFICIAL POSTERIOR LATERAL AND ANTERIOR COMPARTMENTS: Make longitudinal fascial incisions, approximately the length of the skin incision, in the superficial posterior, lateral, and then anterior compartments. STEP 4 SINGLE-INCISION TECHNIQUE DECOMPRESS THE DEEP POSTERIOR COMPARTMENT: 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. STEP 5 SINGLE-INCISION TECHNIQUE POSTOPERATIVE PROTOCOL: After appropriate operative fixation and/or debridement of nonviable tissue, dress the wounds with a VAC device. STEP 1 DUAL-INCISION TECHNIQUE POSITION THE PATIENT: Position the patient, administer antibiotics, and prepare and drape the limb as described in Step 1 for the single-incision technique. STEP 2 DUAL-INCISION TECHNIQUE MAKE THE ANTEROLATERAL SKIN INCISION: Make an incision centered over the anterolateral aspect of the leg to provide access to the anterior and lateral compartments of the leg. STEP 3 DUAL-INCISION TECHNIQUE DECOMPRESS THE ANTERIOR AND LATERAL COMPARTMENTS: 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. STEP 4 DUAL-INCISION TECHNIQUE MAKE THE POSTEROMEDIAL SKIN INCISION: Make an incision centered over the posteromedial aspect of the leg to provide access to the superficial and deep posterior compartments of the leg. STEP 5 DUAL-INCISION TECHNIQUE DECOMPRESS THE SUPERFICIAL AND DEEP POSTERIOR COMPARTMENTS: Through the posteromedial skin incision, identify both the deep and the superficial posterior compartments and incise their fascia longitudinally for adequate decompression. STEP 6 DUAL-INCISION TECHNIQUE POSTOPERATIVE PROTOCOL: Follow the same postoperative protocol as outlined in Step 5 for the single-incision technique. RESULTS: Both the single and the dual-incision techniques are effective for relieving elevated intracompartmental pressures to prevent myonecrosis.IndicationsContraindicationsPitfalls & Challenges.