Leg Fasciotomy

Leg Fasciotomy

M. Timothy Hresko, MD

Patient Positioning

  • Supine on an operating table.

  • Bump underneath ipsilateral buttocks to prevent patient external rotation

  • Tourniquet

Surgical Approaches

  • Two-incision fasciotomy: medial and lateral

  • Incisions may be modified depending on the need for fracture fixation or in relationship to open wounds associated with open fractures or penetrating injuries

  • Anterolateral incision

    • Incision centered one-finger breadth anterior to anterior border of fibula with the fibular head and lateral malleolus as landmarks (Figure 27-1)

      Figure 27-1 ▪ Clinical photo showing incision line for lateral approach.

    • Once skin and subcutaneous tissue retracted, the fascia is easily identified with the lateral intermuscular septum being identified

    • Lateral intermuscular septum identification is the key to assessing boundaries between anterior and lateral compartments (Figures 27-2 and 27-3)

    • A transverse fascial incision should be done which connects the anterior and lateral compartments

    • Metzenbaum scissors and forceps can be used to longitudinally release the anterior compartment fascia

    • Identification of the deep peroneal nerve should be done and should be seen at the level of the tibial tubercle anterior to the lateral intermuscular septum confirming the release of the compartment

    • Distally, the superficial peroneal nerve traverses posterior to anterior from the lateral compartment into the anterior compartment approximately 10 cm above the tip of the lateral malleolus

    • The lateral compartment fascia may then be released longitudinally in the same manner

  • Medial incision

Feb 5, 2020 | Posted by in ORTHOPEDIC | Comments Off on Leg Fasciotomy
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