Operative approaches: Compartment Syndrome

Two incision approach

  • In an appropriately marked and consented patient. I would complete the WHO checklist.
  • Patient would be supine on the table.
  • Incision to decompress the deep and superficial posterior compartment. 2cm posterior to posterior lateral tibial border. extend all the way down the leg. The perforators would be 5, 10 , 15cm from the medial mal. retract the saphenous vein and nerve anteriorly. Release arch of soleus. 
  • The lateral and anterior compartment would be decompressed by an incision down the legnth of the leg midway between the tibial border and fibula.
  • Assess colour, consistency and contractility of the compartments. Debride tissue.
  • Vac dressing return after 24-48 hours

4 compartments

Anterior compartment
–  tibialis anterior
– extensor hallucis longus
– extensor digitorum longus
– peroneus tertius
 
Lateral compartment
– peroneus longus
– peroneus brevis
 
Deep posterior compartment
– tibialis posterior
– flexor digitorum longus
– flexor hallucis longus
 
Superficial posterior compartment
– gastrocnemius 
– soleus
– plantaris

Two incision approach.

In an appropriately marked and consented patient. I would complete the WHO checklist.

  • Patient would be supine on the table with arm board.
  • Volar – incision starts radial to FCU at wrist to medial epicondyle. may extend to release carpal tunnel. Between FCU and FDS.
  • Dorsal – Dorsal longitudinal incision 2cm distal to lateral epicondyle towards midline of wrist. Between EDC and ECRB.
  • Assess colour, consistency and contractility of the compartments. Debride tissue.
  • Vac dressing return after 24-48 hours

3 compartments

Volar
  • PT
  • FCR
  • PL
  • FCU
  • FDS
  • FDP
  • FPL
  • Pronator quadratus

Dorsal

  • ED
  • Supinator
  • EDM
  • ECU
  • APL
  • APB
  • EI
  • EPL
Mobile wad
  • Brachioradialis
  • ECRL
  • ECRB
Please log in to join the chat