Lower Limb Fasciotomy

4 compartment lower limb fasciotomy

Compartments of the lower limb:
1) Anterior Compartment:
- Tibialis anterior
- Extensor hallucis longus
- Extensor digitorum longus
- peroneus tertius mm.
- deep peroneal nerve
- anterior tibilalis atery and venae communicantes

2) Lateral Compartment
- Peroneus longus m
- Peroneus brevis m.
- Superficial peroneal n.

3) Posterior Compartment:
- soleus m.
- gastrocnemius m.
- Palntatris tendon

4) Deep Posterior Compartment:
- Flexor hallicus longus
- Tibialis posterior
- Flexor digitorum longus mm.
- Tibial nerve
- Posterior tibial artery and venae communicantes

4 compartment fasciotomy involves 2 longitudinal incisions ~30 cm long.  Anterior and Lateral compartments are decompressed with a lateral incision ~2cm anterior to fibula.  6-8 cm skin flaps are raised.  Anterior compartment is decompressed with 25cm longitudinal incision lateral to the anterior edge of the tibia.  Make a transverse incision in the fascia to find the intermuscular septum then the lateral compartment decompressed with a 25cm longitudinal incision in the fascia 1cm posterior to the intermuscular septum.

The Posterior and Deep Posterior compartments are then decompressed with a 30 cm longitudinal skin incision 2cm posterior to the tibia.  6-8 cm skin flaps are raised.  The posterior compartment is decompressed with a 25 cm incision in the fascia 2 cm posterior to the posterior border of the tibia.  The deep posterior compartment is accessed by dividing the soleus muscle off of the posterior border of the tibia and performing a 25 cm longitudinal incision posterior to the posterior border of the tibia.  Watch out for the posterior tibial artery and venae communicantes lower in the leg in the deep posterior compartment