Single and Dual-Incision Fasciotomy of the Lower Leg

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WINDSOR UNIVERSITY SCHOOL OF MEDICINE

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Presentation transcript:

Single and Dual-Incision Fasciotomy of the Lower Leg by Keerat Singh, Jesse E. Bible, and Hassan R. Mir JBJS Essent Surg Tech Volume 5(4):e25 November 11, 2015 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Single-incision fasciotomy landmarks Single-incision fasciotomy landmarks. a = anterior tibial crest, b = lateral knee joint line, c = fibular head, d = lateral malleolus, and e = gastrocnemius muscle body. Single-incision fasciotomy landmarks. a = anterior tibial crest, b = lateral knee joint line, c = fibular head, d = lateral malleolus, and e = gastrocnemius muscle body. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Full-thickness skin flaps with visualization of anterior and lateral compartments. a = peroneus longus tendon under lateral compartment fascia, b = anterior intermuscular septum, and c = lateral intermuscular septum. Full-thickness skin flaps with visualization of anterior and lateral compartments. a = peroneus longus tendon under lateral compartment fascia, b = anterior intermuscular septum, and c = lateral intermuscular septum. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Location of superficial peroneal nerve Location of superficial peroneal nerve. a = superficial peroneal nerve, b = anterior compartment fascia, c = lateral compartment fascia, d = fibula, and e = peroneus brevis muscle body. Location of superficial peroneal nerve. a = superficial peroneal nerve, b = anterior compartment fascia, c = lateral compartment fascia, d = fibula, and e = peroneus brevis muscle body. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Fascial incisions to decompress superficial posterior, lateral, and then anterior compartments. a = lateral compartment fascia, b = anterior tibialis tendon, c = anterior compartment incision, d = lateral compartment incision, e = superficial posterior comp... Fascial incisions to decompress superficial posterior, lateral, and then anterior compartments. a = lateral compartment fascia, b = anterior tibialis tendon, c = anterior compartment incision, d = lateral compartment incision, e = superficial posterior compartment incision, f = superficial posterior compartment fascia, and g = gastrocnemius muscle body. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Identifying the lateral intermuscular septum Identifying the lateral intermuscular septum. a = lateral compartment fascia, b = peroneus longus tendon, c = peroneus brevis muscle body, d = lateral intermuscular septum, and e = gastrocnemius muscle body. Identifying the lateral intermuscular septum. a = lateral compartment fascia, b = peroneus longus tendon, c = peroneus brevis muscle body, d = lateral intermuscular septum, and e = gastrocnemius muscle body. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Entrance to deep posterior compartment Entrance to deep posterior compartment. a = posterior border of fibula and site of longitudinal incision, b = lateral intermuscular septum, c = flexor hallucis longus muscle body, d = peroneus longus muscle body, and e = fascia overlying lateral compartment. Entrance to deep posterior compartment. a = posterior border of fibula and site of longitudinal incision, b = lateral intermuscular septum, c = flexor hallucis longus muscle body, d = peroneus longus muscle body, and e = fascia overlying lateral compartment. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Landmarks for anterolateral skin incision in dual-incision fasciotomy Landmarks for anterolateral skin incision in dual-incision fasciotomy. a = anterior tibial crest, b = anterolateral skin incision, c = fibular head, d = lateral knee joint line, and e = tibiotalar joint. Landmarks for anterolateral skin incision in dual-incision fasciotomy. a = anterior tibial crest, b = anterolateral skin incision, c = fibular head, d = lateral knee joint line, and e = tibiotalar joint. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Fascial incisions to decompress lateral and anterior compartments Fascial incisions to decompress lateral and anterior compartments. a = anteroinferior border of patella, b = fascial incision in anterior compartment, c = tibialis anterior tendon, d = peroneus longus tendon, e = fascial incision in lateral compartment, and... Fascial incisions to decompress lateral and anterior compartments. a = anteroinferior border of patella, b = fascial incision in anterior compartment, c = tibialis anterior tendon, d = peroneus longus tendon, e = fascial incision in lateral compartment, and f = anterior intermuscular septum. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Landmarks for medial skin incision in dual-incision fasciotomy Landmarks for medial skin incision in dual-incision fasciotomy. a = medial knee joint line, b = anterior tibial crest, c = medial malleolus, d = posterior border of tibia, and e = incision mark. Landmarks for medial skin incision in dual-incision fasciotomy. a = medial knee joint line, b = anterior tibial crest, c = medial malleolus, d = posterior border of tibia, and e = incision mark. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Approach to superficial and deep posterior compartments through medial incision. a = gastrocnemius muscle body under superficial posterior compartment fascia, b = Achilles tendon, and c = medial malleolus. Approach to superficial and deep posterior compartments through medial incision. a = gastrocnemius muscle body under superficial posterior compartment fascia, b = Achilles tendon, and c = medial malleolus. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Decompression of deep posterior compartment Decompression of deep posterior compartment. a = soleus muscle attachment to posterior part of tibia, b = superficial posterior compartment fascia over gastrocnemius muscle body, c = soleus muscle as seen through longitudinal incision that provides access i... Decompression of deep posterior compartment. a = soleus muscle attachment to posterior part of tibia, b = superficial posterior compartment fascia over gastrocnemius muscle body, c = soleus muscle as seen through longitudinal incision that provides access into deep posterior compartment, and d = tibia. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Release of soleus bridge Release of soleus bridge. a = inferomedial border of patella, b = soleus muscle body origin after release from posteromedial aspect of tibia, c = fascia over gastrocnemius muscle, d = posteromedial border of tibia, and e = incision to access deep posterior ... Release of soleus bridge. a = inferomedial border of patella, b = soleus muscle body origin after release from posteromedial aspect of tibia, c = fascia over gastrocnemius muscle, d = posteromedial border of tibia, and e = incision to access deep posterior compartment. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Decompression of superficial posterior compartment Decompression of superficial posterior compartment. a = fascia overlying gastrocnemius muscle body, b = gastrocnemius muscle, c = incision for access into superficial posterior compartment, d = incision for access into deep posterior compartment, and e = po... Decompression of superficial posterior compartment. a = fascia overlying gastrocnemius muscle body, b = gastrocnemius muscle, c = incision for access into superficial posterior compartment, d = incision for access into deep posterior compartment, and e = posteromedial border of tibia. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Decompressed superficial and deep posterior compartments Decompressed superficial and deep posterior compartments. a = fascia overlying superficial posterior compartment, b = gastrocnemius muscle body, c = fascial incision along soleus muscle body for access to deep posterior compartment, and d = posteromedial as... Decompressed superficial and deep posterior compartments. a = fascia overlying superficial posterior compartment, b = gastrocnemius muscle body, c = fascial incision along soleus muscle body for access to deep posterior compartment, and d = posteromedial aspect of tibia. Keerat Singh et al. JBJS Essent Surg Tech 2015;5:e25 ©2015 by The Journal of Bone and Joint Surgery, Inc.