Leg Compartment Release - Two Incision Approach

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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Execute surgical walkthrough

  • describe key steps of the procedure to the attending verbally prior to the start of the case
  • describe potential complications and the steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • curved mayo scissors

2

Room setup and equipment

  • standard OR table

3

Patient positioning

  • patient supine
G

Superificial Anterolateral Incision

1

Mark the incision halfway between the fibula and the crest of the tibia

  • make the incision directly over the anterolateral intermuscular septum
  • extend the incision 15 to 20 cm distally

2

Identify the superficial peroneal nerve

  • the nerve is 10 to 12 cm proximal to the tip of the lateral malleolus
H

Anterior Compartment Release through Anterolateral Incision

1

Incise the anterior fascia

  • localize the intermuscular septum at the proximal end of the wound
  • make a short transverse incision anterior to the intermuscular septum
  • the transverse incision should be long enough to fit the tip of curved mayo scissors for the fasciotomy

2

Perform the fasciotomy

  • run the scissors cephalad and caudally

3

Assess the musculature of the anterior compartment

  • evaluate the color, consistency, contractility and capillary refill
I

Lateral Compartment Release through Anterolateral Incision

1

Incise the lateral fascia

  • localize the intermuscular septum at the proximal end of the wound
  • make a short transverse incision posterior to the intermuscular septum
  • the incision should be long enough to fit the tip of curved mayo scissors for the fasciotomy

2

Perform the fasciotomy

  • run the scissors cephalad and caudally

3

Assess the musculature of the lateral compartment

  • evaluate the color, consistency, contractility and capillary refill
J

Superficial and Deep Compartment Release

1

Mark the incision 2 cm medial to the posterior border of the tibia

  • make an anteriormedial incision 2 cm medial to the posterior medial border of the tibia
  • make incision 15-20 cm distally
  • retract the saphenous vein and nerve anteriorly
  • perform fasciotomy
  • incise the fascia directly under the incision for a short distance
  • place the tip of the curved mayo scissors into the incision
  • direct the mayo scissors cephalad and caudally
  • this decompresses the superficial posterior compartment

2

Assess the musculature of the superficial posterior compartment

3

Release the deep posterior compartment

  • release the fascia distally and run mayo scissors proximally through and under the soleus bridge
  • release the the soleus attachment to the tibia more than half way
  • release the fascia over the posterior tibia muscle

4

Assess the musculature of the deep compartment

K

Superficial Compartment Release through the Anteromedial Incision

1

perform fasciotomy

2

incise the fascia directly under the incision for a short distance

  • place the tip of the curved mayo scissors into the incision
  • direct the mayo scissors cephalad and caudally
  • this decompresses the superficial posterior compartment

3

Assess the musculature of the superficial compartment

L

Deep Compartment Release through Anteromedial Incision

1

Release the deep posterior compartment

  • release the fascia distally and run mayo scissors proximally
  • continue release through and under the soleus bridge
  • release the the soleus attachment to the tibia more than half way

2

Assess the musculature of the deep compartment

N

Wound Closure

1

Place negative pressure dressings

2

Place in splint with the ankle in neutral

  • this prevents equinus contracture

3

Return to OR in 48-96 hours for additional wound debridement

4

Return to OR in 5-7 days for primary wound closure

Postoperative Patient Care
 

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