Name:
19 Fasciotomy Lower Leg
Description:
19 Fasciotomy Lower Leg
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/e7424f85-d3a9-4dee-a57d-971e6e230d8f/thumbnails/e7424f85-d3a9-4dee-a57d-971e6e230d8f.jpg?sv=2019-02-02&sr=c&sig=xA7333I5Yq6seZ%2BWb0InbzNwXezMjIIXNKK%2FO2DHvMI%3D&st=2024-12-21T14%3A34%3A14Z&se=2024-12-21T18%3A39%3A14Z&sp=r
Duration:
T00H06M16S
Embed URL:
https://stream.cadmore.media/player/e7424f85-d3a9-4dee-a57d-971e6e230d8f
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/e7424f85-d3a9-4dee-a57d-971e6e230d8f/4789148841001.mp4?sv=2019-02-02&sr=c&sig=5PAoQLmG%2BOFcfH6e8IOpONM4gOfi9PK%2FZrvThOoup8k%3D&st=2024-12-21T14%3A34%3A14Z&se=2024-12-21T16%3A39%3A14Z&sp=r
Upload Date:
2022-03-03T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
In this video we will discuss the proper technique for performing a fasciotomy of the leg.
Segment:1 Objectives.
We will begin by discussing the relevant anatomy, the instruments and positioning, the exposure and technique and, finally, the tips and pitfalls of this procedure.
Segment:2 Anatomy.
The leg located below the knee, consists of four myofascial compartments. On the lateral aspect of the leg are located at the anterior compartment and the lateral compartment. These are separated by a thick intermuscular fascial septum.
The identification of the septum is critical to a proper four-compartment fasciotomy of the leg. Medially located are the superficial posterior and deep posterior compartments of the leg. Note that the fascia over line the lateral aspect of the leg is continuous over the anterior and lateral compartments. Deep to this fascia lie the anterior and lateral compartments, separated by the inter muscular septum.
Within the anterior compartment superficially lie the Tibias Anterior muscle and the Extensor Digitorum Longus muscles. When the Extensor Hallucis Longus muscle, deep to this muscles and not visible here. In the lateral compartment lies the Peroneus Longus muscles superficially and deep lies the Peroneus Brevis muscle. Note the location of the Superficial Peroneal nerve in the lateral compartment. This nerve should be preserved during a four-compartment fasciotomy.
On the medial aspect of the leg, note the fascia over the posterior compartments and the greater saphenous vein superficial to it. The vein should be preserved during the fasciotomy. Immediately deep into the fascia lies the superficial posterior compartment, which contains a soleus muscle. Deep to the superficial compartment lies the deep posterior compartment containing the flexor digitorum longus muscle, tibialis posterior and flexor hallucis longus muscles and the neuromuscular bundle of the leg.
Segment:3 Instrumentation and Positioning.
The patient should be positioned supine. A support would be helpful for the medial fasciotomy. The hair should be clipped and the leg prepped from the midthigh to the foot. A standard instrument tray is sufficient. A lateral incision is used for fasciotomy of the lateral and the interior compartments of the leg. The tibial tuberosity and the head of the fibula are identified and the incision is marked, extending from the tibial tuberosity to just above the lateral malleolus.
Approximately midway between the tibia and fibula or two finger breadths below the lateral edge of the tibia. A scalpel is used to incise the skin and subcutaneous tissue to expose the underlying fascia. If necessary, subcutaneous skin flaps may be raised and self-retaining retractors are placed for exposure. A transverse incision is made in the fascia using a scalpel in order to aid with identification of the inter muscular septum between the anterior and lateral compartments.
Next, the Metzenbaum scissors are used to bluntly create a subfascial plane and used to incise the fascia proximally and distally by advancing the scissors while partially opening with the fascia between its blades. When incising the lateral compartment, it is critical to direct the incision towards the lateral malleolus in order to avoid inadvertent injury to the superficial peroneal nerve. The intermuscular septum must be identified in order to ensure that both the lateral and interior compartments have been released.
Medially, the surface landmarks are the tibial tuberosity, medial edge of the tibia and the medial malleolus. The incision is marked approximately two finger breadths posterior to the tibial margin extending from the tibial tuberosity to just above the medial malleolus. The skin and subcutaneous soft tissue are once again incised using a scalpel. Care should be to taken to not injure the underlying greater saphenous vein, which lies superficial to the fascia.
The fascia is then incised using a scalpel. Once again the Metzenbaum scissors are used the bluntly create a subfascial plane and the fascia is incised both proximal and distal. Once the fascia has been incised, the superficial posterior compartment has been decompressed. In order to decompress the deep posterior compartment, the soleus muscle is detached from its incision to the tibia. Decompression of the deep posterior compartment is confirmed by the identification of the posterior tibial neuromuscular bundle.
Segment:4 Tips and Pitfalls.
Delayed diagnosis is the most common problem in management of compartment syndrome. With a high index of suspicion, compartment pressures should be measured using a Stryker device. Identification of the intermuscular septum is essential during anterior and lateral fasciotomy. Avoid injury to the superficial peroneal nerve with the lateral incision, as it lies directly under the fascia. During fasciotomy of the superficial and deep posterior compartments avoid injury to the greater saphenous vein as it lies quite superficial within the subcutaneous soft tissue.
The deep posterior compartment is the most commonly missed. Release should be confirmed with identification of the neuromuscular bundle. Avoid limited skin incision as inadequate skin incisions may result in an inadequate fasciotomy. Thank you.
Form Title Download
Form Title Bookmark
Form Title Share
Form Title Cite
