The Efficacy of a Single-Incision Versus Two-Incision Four-Compartment Fasciotomy of the Leg: A Cadaveric Model

Replicating an established cadaveric model, this study investigates the efficacy of single-incision and 2-incision fasciotomies to satisfactorily decompress all 4 compartments of the leg. We hypothesized that both techniques would adequately release each compartment and that a compartment syndrome could not be recreated in the deep posterior compartment after releases by either technique.

Acute compartment syndrome was simulated in 8-paired, fresh-frozen human cadaver legs by infusing normal saline into all 4 compartments. Subsequent 4-compartment fasciotomies were performed on each pair using both techniques. After fascial release, the deep posterior compartment was reinfused in an attempt to recreate an acute compartment syndrome. Statistical analysis was performed using the Student t-test with significance set at a P value less than 0.05.

Sustainable pressures greater than 60 mm Hg were established in all 4 compartments of each specimen. Postfasciotomy pressures were all reduced to less than 30 mm Hg using both single-incision and 2-incision techniques. There were no statistically significant differences in postrelease pressures between the 2 techniques in any compartment. The average postrelease pressure in the deep posterior compartment was 4.6 mm Hg (range 0-10 mm Hg) with the single-incision technique and 5.6 mm Hg (range 1-10 mm Hg) with the 2-incision technique (P = 0.44). After complete fasciotomies, it was not possible to recreate the elevated pressures of acute compartment syndrome in the deep posterior compartment of any specimen.

A single-incision, 4-compartment fasciotomy is as effective as a 2-incision technique for release of acute compartment syndrome in this cadaveric model.