Leg Compartment Release - Single 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

Perifibular Approach

1

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

  • make a 10 cm incision dircelty over the midportion of the fibula
  • retract the skin anteriorly
H

Anterior and Lateral Compartment Release

1

Incise the anterior fascia

  • release the fascia of the anterior and lateral compartment longitudinally in a proximal and distal direction
  • retract the skin posteriorly
I

Superficial Posterior Compartment Release

1

Incise the lateral fascia

  • release the fascia that overlies the lateral head of the gastrocnemius
  • incise the fascia over the superficial posterior compartment for a distance of 15 cm
  • evaluate the color, consistency, contractility and capillary refill
J

Deep Posterior Compartment Release

1

Expose and release the deep posterior compartment

  • retract the anterior and lateral compartments anteriorly and the superficial posterior compartment posteriorly
  • release the soleal bridge from the fibula
  • identify the fascia over the FHL

2

Incise the fascia over the FHL

3

Retract the gastrocsoleus complex posterior

  • retract the FHL laterally
  • this exposes the posterior tibial artery, tibial nerve and peroneal artery that is overlying the tibialis posterior
K

FHL Release

1

Perform release

  • incise the fascia around the tibialis posterior and the interval between the muscle and the origins of the flexor hallucis longus is widened if it is constrictive
L

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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