Timing - Compartment syndrome is a surgical emergency and surgery should occur within 1 hour of the decision to operate.
Early Plastics involvement – Consider involving a plastic surgeon as soon as the decision to operate is made. Open fascial decompression of all involved compartments, taking into account possible reconstructive options.
Procedure - Excise all necrotic muscle. Document the compartments decompressed.
Lower leg fasciotomies – Perform a two-incision four-compartment decompression
Incomplete lower leg fasciotomies cause significant morbidity. The common reasons are:
- Identification of the septum dividing the anterior and lateral compartments. This can be avoided by making an initial transverse incision in the fascia overlying the septum, then deliberately opening the anterior and lateral compartments separately, creating a so called “H” incision
- Incomplete development of the deep posterior compartment release by not deliberately taking the soleus muscle fibres off the posterior tibia. If performed correctly, the neurovascular bundle should be exposed in a fully decompressed deep posterior compartment
- Fascial incisions are too short and do not cover the entire extent of the fascial compartment, either at the knee or ankle levels
Re-look – Re-explore at 48 hours (or earlier if indicated)