synonyms:compartment syndrome release, fasciotomy, 4 compartment fasciotomy
Leg Fasciotomy CPT
Leg Fasciotomy Indications
Leg Fasciotomy Contraindications
- Anticoagulation / bleeding disorders (must be corrected prior to surgery)
Leg Fasciotomy Alternatives
Leg Fasciotomy Pre-op Planning
Leg One Incision Fasciotomy Technique
- Pre-op antibiotics.
- Anesthesia: General or regional.
- Postion: supine with bump under hip. Thigh tourniquet.
- Prep and drape in standard sterile fashion
- Incision over the fibula from 5cm distal to fibular head to 5cm proximal to the lateral malleolus.
- Identify the septum between the anterior and lateral compartments.
- Release the fascia 1cm anterior and 1cm posterior to the septum releasing the anterior and lateral compartments.
- Avoid injury to the superficial peroneal nerve distally.
- Elevate the lateral compartment musculature off the posterior intramuscular septum.
- Incise the posterior intramuscular septum releasing the lateral portion of the superficial posterior compartment.
- Elevate the superficial compartment posteriorly to access and release the deep posterior compartment. The posterior compartment can be found by following the interosseous membrane from the posterior aspect of the fibula.
- Ensure FDL has been adequately released. (Hislop M, AJSM 2003;31:770).
- Close the subcuteous tissue and skin.
Two incision Fasciotomy Technique
- Anterolateral incision 2 cm anterior to fibular shaft
- find anterior intermuscular septum
- release anterior compartment longitudinally ½ way between intermuscular septum and tibia
- release lateral compartment in line with fibula (danger: Superficial peroneal nerve)
- Posteromedial incision 2 cm posterior to posteromedial edge of tibia
- at depth of fascia, undermine anteriorly to posterior tibial margin
- incise posterior superficial compartment
- release posterior deep compartment
- may need to release soleus origin from tibia proximally
- prevent retraction of skin edges with gently tensioned vessel loops weaved through staples at skin edges
- Mubarak and Owen JBJS 1977
Leg Fasciotomy Complications
- Incidence =4.5-13%
- Recurrence=7-17%; Recurrence occurs at a mean of 23.5 months post op. Potential causes of recurrence: postsurgical fibrosis/scar, iinadequate fascial release, failure to recognize involvement of other compartments, nerve compression, misdiagnosis.
- Wound infection
- Nerve entrapment / Nerve injury
- Arterial injury
- Hematoma / hemorrhage / seroma
Leg Fasciotomy Follow-up care
- 7-10 Days:
- 3 Weeks:
- 6 Weeks:
- 2 Months:
- 3 Months:
- 6 Months:
Leg Fasciotomy Outcomes
Leg Fasciotomy Review References
- Fraipont, MJ. JAAOS 2003;11:268
- Detmer DE, AJSM 1985;13:162
- Bray AW et al: Chronic exercise-induced compartment pressure elevation measured with miniaturized fluid pressure monitor. American Journal of Sports Medicine 1988;16: pp. 610-615.
- DeLee & Drez's, Orthopaedic Sports Medicine: 3e; 2009
- Aweid O, Del Buono A, Malliaras P, Iqbal H, Morrissey D, Maffulli N, Padhiar N. Systematic review and recommendations for intracompartmental pressure monitoring in diagnosing chronic exertional compartment syndrome of the leg. Clin J Sport Med. 2012 Jul;22(4):356-70. doi: 10.1097/JSM.0b013e3182580e1d.
- Pedowitz RA, Hargens AR, Mubarak SJ, Gershuni DH. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med. 1990 Jan-Feb;18(1):35-40.
- Waterman BR, Liu J, Newcomb R, Schoenfeld AJ, Orr JD, Belmont PJ Jr. Risk factors for chronic exertional compartment syndrome in a physically active military population. Am J Sports Med. 2013 Nov;41(11):2545-9.
- Schepsis AA, Fitzgerald M, Nicoletta R. Revision surgery for exertional anterior compartment syndrome of the lower leg: technique, findings, and results. Am J Sports Med. 2005 Jul;33(7):1040-7.