Single and Dual Incision Fasciotomy of the Lower Leg

Compartment syndrome of the leg is an orthopaedic emergency and can be treated with single or dual-incision fasciotomy, allowing for necessary decompression of all four compartments. The choice of surgical incisions should be based on surgeon preference and experience as there is no significant difference with regard to complications between the two approaches1.

The single-incision technique involves a longitudinal skin incision along the posterolateral aspect of the leg in line with the fibula2. Full-thickness soft-tissue flaps are elevated, and a longitudinal incision is made in the fascia of the superficial posterior, lateral, and then anterior compartments. Through the lateral compartment, the fascial attachment of the lateral intermuscular septum is traced to its origin along the fibula and incised, providing decompression of the deep posterior compartment. After appropriate decompression and debridement of nonviable tissues, the wound may be managed with a vacuum-assisted closure (VAC) device or moistened dressings. Patients return to the operating room in two to four days for additional wound management.
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