Lower extremity fasciotomy techniques
- J Gregory Modrall, MD
J Gregory Modrall, MD
- Professor of Surgery
- University of Texas Southwestern Medical Center
- Section Editors
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery, Texas A&M Health Science Center
- Vice Chair of Vascular Surgical Services, Baylor Heart and Vascular Hospital at Dallas
Extremity fasciotomy is the only recognized treatment for acute compartment syndrome. The leg is the most frequently affected site in the lower extremity requiring fasciotomy [1,2]. Although less common, acute compartment syndrome can occur in the thigh, buttock, and foot [3-7]. In addition, patients who suffer from chronic compartment lower extremity syndromes may also benefit from fasciotomy.
For acute compartment syndrome, failure to recognize and decompress the muscular compartments in a timely fashion can compromise the extremity or the patient's life. The indications for and techniques of lower extremity fasciotomy for emergent fasciotomy of the leg, thigh, buttock and foot will be reviewed here. Alternative techniques for chronic compartment syndromes are briefly discussed. Patient management following fasciotomy, including wound care, is discussed elsewhere. (See "Patient management following extremity fasciotomy".)
The clinical evaluation and diagnostic criteria for acute compartment syndrome and chronic exertional compartment syndrome are discussed in separate reviews. (See "Acute compartment syndrome of the extremities" and "Chronic exertional compartment syndrome".)
Any pathologic process that results in increased pressure within a muscular compartment that exceeds the perfusion pressure of the tissue has the potential to cause compartment syndrome and extremity ischemia.
Acute compartment syndrome — Fasciotomy is indicated for the treatment of acute compartment syndrome. Recognition of the syndrome should prompt treatment. The clinical features and intra-compartment pressure criteria for the diagnosis of acute compartment syndromes are discussed elsewhere. (See "Acute compartment syndrome of the extremities", section on 'Clinical features' and "Acute compartment syndrome of the extremities", section on 'Measurement of compartment pressures'.)
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- Acute compartment syndrome
- Chronic compartment syndrome
- Prophylactic fasciotomy
- COMPARTMENT ANATOMY
- - Superficial peroneal nerve
- Prophylactic antibiotics
- Antithrombotic therapy
- Other considerations
- FASCIOTOMY TECHNIQUES
- Leg fasciotomy
- - Double incision fasciotomy
- - Single incision fasciotomy
- Thigh fasciotomy
- Buttock fasciotomy
- Foot fasciotomy
- Alternative fasciotomy techniques for elective compartment decompression
- WOUND MANAGEMENT
- TECHNICAL COMPLICATIONS
- Incomplete fasciotomy
- Neurovascular injury
- Consequences of a delayed fasciotomy
- Prophylactic versus therapeutic fasciotomy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS