Editing Compartment syndrome (section)

=== '''Four-compartment decompression (double-incision technique):''' ===

*** Use a generous incision - 12-20cm - on both sides
*** Lateral/anterior: 
**** Incise between fibular shaft and crest of tibia (about 4cm lateral to crest of tibia), right over the intermuscular septum between the anterior and lateral compartments. 
**** Raise skin flaps medially and laterally to expose the fascia of the anterior and lateral compartments
**** Clearly identify the intermuscular septum so you can be sure they are both decompressed
**** Open both anterior and lateral compartments with separate, parallel, 12-20cm fascial incisions using Metz scissors (elevate scissors off muscle to avoid injury to nerves, and terminate incisions 5cm distal to fibular heads to avoid the nerves there)
*** Posterior compartments:
**** Incise 1-2cm posterior to tibia, avoiding GSV and nerve
**** Decompress superficial posterior compartment with a longitudinal incision along gastrocnemius fascia
**** To decompress the deep posterior compartment, divide the attachments of the soleus muscle to the tibia or push them away bluntly, exposing the fascia overlying tibialis posterior and the flexor muscles of the foot, then incise the fascia longitudinally, avoiding injury to the posterior tibial artery. Need to see the posterior tibial neurovascular bundle to be assured of having decompressed the deep compartment.
** Single-incision technique
*** Single incision over fibula down to lateral malleolus
*** Most surgeons now favour double-incision technique
** Selective decompression:
*** If opening the lateral, anterior and superficial posterior compartments normalises the pressure in the deep posterior compartment, no further decompression is required
**

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