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Single and Dual-Incision Fasciotomy of the Lower Leg
Keerat Singh1, Jesse E Bible1, Hassan R Mir1
1Vanderbilt Orthopaedic Institute, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232. E-mail address for H.R. Mir: hassan.mir@vanderbilt.edu.
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.
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