Lower Extremity Fasciotomy: Indications and Technique

All clinicians caring for traumatically injured patients must be able to recognize and treat (or refer for treatment) compartment syndrome (CS) of the extremities. CS results from a number of etiologies (traumatic and non-traumatic) with the final common being ischemia and necrosis as a result of impaired arterial inflow due to increased compartmental pressures. Preventable morbidity and mortality results from failure to identify and treat CS in a timely fashion and is a common source of litigation. Successful treatment of CS requires prompt recognition and complete surgical release of the compartments involved, and requires a thorough understanding of the relevant anatomy. CS most commonly affects the lower extremity below the knee. This article will present the pathophysiology, epidemiology, diagnosis, relevant anatomy, and treatment of CS, emphasizing the proper performance of a two incision four compartment fasciotomy of the lower extremity.