The soleus muscle is essentially “stripped” from the back of the tibia bluntly to expose the deep posterior compartment (Fig. This maneuver exposes the fascia overlying the tibialis posterior and one enters the deep posterior compartment, which may also be confirmed by identifying the posterior tibial neurovascular bundle. Once this compartment is decompressed, the soleus muscle is identified and separated from the underside of the tibia. The fascia of the superficial posterior compartment is now encountered and is decompressed via a longitudinal incision along the gastrocnemius fascia.
#Compartments of leg fasciotomy skin#
While extending the skin incision through the subcutaneous tissue, the surgeon should be careful not to damage the greater saphenous vein. This craniocaudal incision extends from 3 fingerbreadths below tibial tuberosity to 3 fingerbreadths above the medial malleolus. An incision is made about 1 thumb breadth posterior to the tibia (see Fig. 12.5).Īttention is now turned to the medial incision to decompress the superficial posterior and deep posterior compartments. Some authors have advocated for connecting the two fascial incisions across the intermuscular septum to form an “H” type incision (Fig. Next, a second lateral incision should be made on the anterior compartment fascia to decompress the anterior compartment in a similar fashion to the lateral compartment using Metzenbaum scissors. Tips of the scissor should be pointed away from the intermuscular septum to avoid damage to the peroneal nerve. A single jaw of the scissor is inserted into the compartment and the scissors are pushed along the line of incision to cut the fascia superiorly and inferiorly. The lateral compartment is incised and then decompressed using Metzenbaum scissors. Once completed, the intermuscular fascial septum between the anterior and lateral compartments are identified. Skin flaps of about 3 cm are raised in each direction. The incision is extended using cautery through the subcutaneous fat to the level of the fascia. This craniocaudal incision extends from 3 fingerbreadths below fibular head to 3 fingerbreadths above the lateral malleolus. An incision is made about 2 finger breadths lateral to the tibia or about 1 fingerbreadth anterior to the fibula (Fig.
The most common compartment involved with CS is the lateral compartment, so one begins decompression with the lateral incision. At the inferior aspect, mark the medial and lateral malleolus. At the superior aspect of the leg, mark the tibial tuberosity anteriorly and the fibular head laterally. In the setting of acute CS, we do not recommend this procedure.įirst, the leg should be circumferentially prepped out and draped from the inguinal crease down to the feet. A single-incision technique has been described for leg fasciotomy. Through lateral and medial incisions, all four compartments can be released. The standard operation used to perform the fasciotomy is a two-incision technique. Before proceeding with a leg fasciotomy, the surgeon must have a thorough understanding of the anatomy (Fig. These include the anterior, lateral, superficial posterior, and deep posterior compartments. The reading should now display compartment pressure The tip of the needle is inserted in to the compartment at the same angle, and 0.3 mL of saline is injected slowly. The apparatus is held at a 45-degree angle and zeroed. Air bubbles are evacuated from the saline-filled syringe. Using a Stryker Manometer to measure a compartment pressure.