Fasciotomy: an appraisal of controversial issues

Fourty-eight fasciotomies performed for conventional indications were analyzed, focusing primarily on the reliability of clinical diagnosis and the effectiveness of the operative technique. Decompression was accomplished immediately after hospital admission or arterial repair in 27 patients and deferred until the appearance of signs and symptoms in 21 others. Myoneural degeneration occurred in the delayed group only as a result of massive trauma or when obvious signs of compartment syndrome were ignored. A high index of suspicion and careful attention to clinical findings were reliable for establishing the diagnosis and indicating the timing of myofascial decompression. Tissue-pressure measurements were not used. The technique of four-compartment fasciotomy through a single lateral incision without fibulectomy was used in 21 limbs and compared with 18 four-compartment fasciotomies utilizing conventional methods. This procedure is rapid, simple, effective, and atraumatic and provides excellent exposure for direct visualization and selective decompression of all compartments and their individual muscles.