Single and Dual-Incision Fasciotomy of the Lower Leg

Singh, Keerat; Bible, Jesse E.; Mir, Hassan R.

doi:10.2106/jbjs.st.o.00007

Cited by 9 publications

(9 citation statements)

References 3 publications

(2 reference statements)

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“…However, releasing the soleal bridge is a necessary and important step for successful decompression of the deep posterior compartment. 18 We found an unacceptably higher rate of damage to the saphenous nerve (16.7%; P = .052) and long saphenous vein (23.3%; P = .011) when using a transverse versus longitudinal skin incision during the approach, but no neurovascular injury occurred when using a longitudinal skin incision. This suggests that neurovascular injury when decompressing the deep posterior compartment is more likely to occur at a superficial level during the skin incision and subcutaneous dissection as opposed to during the fascial release; particular care must therefore be used when executing the approach to this procedure.…”

Section: Discussionmentioning

confidence: 73%

“…Traditionally, skin and fascial incisions for lower limb fasciotomy have been longitudinal, although some recent studies have demonstrated that transverse incisions may be a suitable alternative. 3 , 19 There has been debate over single- versus dual-incision fasciotomies to decompress the lower leg, 13 , 18 with the single-incision technique potentially offering reduced operative time, but at the theoretical expense of less effective decompression. Bible et al 1 found no difference in patient outcomes after comparing single- and dual-incision techniques.…”

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confidence: 99%

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Minimally Invasive Lower Leg Fasciotomy for Chronic Exertional Compartment Syndrome—How Safe Is It? A Cadaveric Study

Grechenig

Valsamis

Müller

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Chronic exertional compartment syndrome (CECS) is a recognized clinical diagnosis in running athletes and military recruits. Minimally invasive fasciotomy techniques have become increasingly popular, but with varied results and small case numbers. Although decompression of the anterior and peroneal compartments has demonstrated a low rate of iatrogenic injury, little is known about the safety of decompressing the deep posterior compartment. Purpose: To evaluate the risk of iatrogenic injury when using minimally invasive techniques to decompress the anterior, peroneal, and deep posterior compartments of the lower leg. Study Design: Descriptive laboratory study. Methods: A total of 60 lower extremities from 30 adult cadavers were subject to fasciotomy of the anterior, peroneal, and deep posterior compartments using a minimally invasive technique. Two common variations in surgical technique were employed to decompress each compartment. Anatomical dissection was subsequently carried out to identify incomplete division of the fascia, muscle injury, neurovascular injury, and the anatomical relationship of key neurovascular structures to the incisions. Results: Release of the anterior and peroneal compartments was successful in all but 2 specimens. There was no injury to the superficial peroneal nerve or any vessel in any specimen. A transverse incision crossing the anterior intermuscular septum resulted in muscle injury in 20% of the cases. Release of the deep posterior compartment was successful in all but 1 specimen when a longitudinal skin incision was used, without injury to neurovascular structures. Compared with a longitudinal incision, a transverse skin incision resulted in fewer complete releases of the deep posterior compartment and a significantly higher rate of injury to the saphenous nerve (16.7%; P = .052) and long saphenous vein (23.3%; P = .011). Conclusion: Minimally invasive fasciotomy of the anterior, peroneal, and deep posterior compartments using longitudinal incisions had a low rate of iatrogenic injury in a cadaveric model. Complete compartment release was achieved in 97% to 100% of specimens when employing this technique. Clinical Relevance: Minimally invasive fasciotomy techniques for CECS have become increasingly popular with purported low recurrence rates, improved cosmesis, and faster return to sport. It is important to determine whether this technique is safe, particularly given the variable rates of neurovascular injury reported in the literature.

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Section: Discussionmentioning

confidence: 73%

mentioning

confidence: 99%

Minimally Invasive Lower Leg Fasciotomy for Chronic Exertional Compartment Syndrome—How Safe Is It? A Cadaveric Study

Grechenig

Valsamis

Müller

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…This allowed for soft tissue recovery by restoring fracture length and alignment. Emergency incision and decompression was instantly performed in order to prevent compartment syndrome [7], and the cross-articular external xation was placed with the nail channel as far away as possible from the position of the second surgical incision [8]. The resulting wound was sutured one week after the incision decompression.…”

Section: Pre-operationmentioning

confidence: 99%

The Staged Treatment for Tibial Plateau Fractures and the Reconstruction of Lateral Column With Autogenous Iliac Bone: an Efficacy Analysis Report

Liu

Xiao

et al. 2021

Preprint

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BackgroundComplications in treating comminuted tibial plateau fractures with extensive soft tissue damage are common. In this study, we discussed the effect of staged treatment in the reconstruction of the lateral column with autogenous iliac bone using case follow-up.MethodsA retrospective analysis of 18 patients with comminuted tibial plateau fractures and extensive soft tissue damage from October 2016 to February 2020 who underwent staged treatment in our hospital. After the soft tissue damage repair, a large autologous iliac bone was used to reconstruct the lateral column of the tibial plateau.ResultsAll 18 patients were followed up over the course of 8-40 months, with an average of 23.44 months. All patients reported zero postoperative infection, skin and soft tissue necrosis, and loosening/breakage of the internal fixation. Regular postoperative review revealed that all patients achieved complete bony union, as evidenced by X-ray film, at 6 months after operation. Knee function (HSS) scores averaged 86.72 points at 1 year after operation; 15 people with 85 points or more, 2 people with 70-84 points, and one with 68 points. The excellent rate, according to HSS was 90%.ConclusionsComplex tibial plateau fractures with extensive soft tissue damage can be effectively remedied with a staged treatment, wherein a lateral column reconstruction is performed using a large iliac bone.

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Section: Pre-operationmentioning

confidence: 99%

The staged treatment for tibial plateau fractures and the reconstruction of lateral column with autogenous iliac bone: an efficacy analysis report

Liu

Liang

et al. 2021

Preprint

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Background: Complications in treating comminuted tibial plateau fractures with extensive soft tissue damage are common. In this study, we discussed the effect of staged treatment in the reconstruction of the lateral column with autogenous iliac bone using case follow-up. Methods: A retrospective analysis of 18 patients with comminuted tibial plateau fractures and extensive soft tissue damage from October 2016 to February 2020 who underwent staged treatment in our hospital. After the soft tissue damage repair, a large autologous iliac bone was used to reconstruct the lateral column of the tibial plateau.Results: All 18 patients were followed up over the course of 8-40 months, with an average of 23.44 months. All patients reported zero postoperative infection, skin and soft tissue necrosis, and loosening/breakage of the internal fixation. Regular postoperative review revealed that all patients achieved complete bony union, as evidenced by X-ray film, at 6 months after operation. Knee function (HSS) scores averaged 86.72 points at 1 year after operation; 15 people with 85 points or more, 2 people with 70-84 points, and one with 68 points. The excellent rate, according to HSS was 90%.Conclusions: Complex tibial plateau fractures with extensive soft tissue damage can be effectively remedied with a staged treatment, wherein a lateral column reconstruction is performed using a large iliac bone.

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Single and Dual-Incision Fasciotomy of the Lower Leg

Cited by 9 publications

References 3 publications

Minimally Invasive Lower Leg Fasciotomy for Chronic Exertional Compartment Syndrome—How Safe Is It? A Cadaveric Study

Minimally Invasive Lower Leg Fasciotomy for Chronic Exertional Compartment Syndrome—How Safe Is It? A Cadaveric Study

The Staged Treatment for Tibial Plateau Fractures and the Reconstruction of Lateral Column With Autogenous Iliac Bone: an Efficacy Analysis Report

The staged treatment for tibial plateau fractures and the reconstruction of lateral column with autogenous iliac bone: an efficacy analysis report

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