compartment fasciotomy of lower extremity

Jepson described ischemic contractures in dog hind legs, resulting from limb hypertension after experimentally induced venous obstruction. The consequences of persistently elevated intra-compartmental pressures were first described by Richard von Volkmann, who documented nerve injury and late muscle contracture from compartment syndrome after supracondylar fracture of the distal humerus. Acute compartment syndrome occurs more commonly in one of the four smaller compartments of the lower leg. In theory, the upper leg muscles are at a lower risk for injury than are the smaller muscles of the lower leg, because the muscles of the thigh can dissipate the large forces of direct trauma, causing less muscle injury and resultant edema. If missed, compartment syndrome can be a limb- and life-threatening condition.Ĭompartment syndrome is most common in the lower leg and forearm, although it can also occur in the hand, foot, thigh, and upper arm. These compartments enclose skeletal muscles along with the neurovascular structures that pass through the compartments. The musculoskeletal structures of the limbs are enclosed within compartments created by investing fascial layers with a limited ability to stretch. Regardless, practitioners should be aware of the patient risk factors, clinical presentation, and management of this potentially limb-threatening condition. Although regional anesthesia is often thought to delay diagnosis and treatment of acute compartment syndrome (ACS), there are only isolated case reports and a lack of evidence-based information to guide the clinical practice. It is an acute condition of the limbs in which the pressure of isolated or groups of poorly compliant muscle compartments increases dramatically and limits local soft tissue perfusion to the point of motor and sensory impairment and neuronal and tissue ischemic necrosis. The medial, lateral, and superficial compartments pass through the entire length of the foot, while the interosseous compartments and the calcaneal compartments are confined to the forefoot and the hind foot, respectively.Table of Contents Acute Compartment Syndrome of the Limb: Implications for Regional Anesthesia INTRODUCTIONĬompartment syndrome is an orthopedic emergency. The foot contains a total of nine compartments, including four interosseous (medial, lateral, deep, and superficial central) and the adductor hallucis compartments that may require decompression in crush injuries to the foot. The deep posterior compartment: Contains the flexor hallucis longus muscle, flexor digitorum longus muscle, tibialis posterior muscles, popliteus muscle, the posterior tibial artery, and the tibial nerve. The superficial posterior compartment: Contains the gastrocnemius muscle, soleus muscles, plantaris muscle, and the sural nerve. The lateral compartment: Contains the peroneus longus and brevis muscles, and the superficial peroneal nerve.

The anterior compartment: Contains the tibialis anterior muscle, extensor halluces muscle, extensor digitorum longus muscle, the anterior tibial artery, and the deep peroneal nerve. The medial compartment contains the adductor muscle group and the gracilis muscle. The posterior compartment contains the biceps femoris, semitendinosus, and semimembranosus muscles and the sciatic nerve. The anterior compartment contains the quadriceps femoris and sartorius muscles, as well as the femoral vessels and femoral nerve. The sciatic nerve is the only major neurovascular structure in the compartments of the buttock. The compartments of the buttock include the gluteus maximus, the gluteus medius/minimus, and the extension of the fascia lata of the thigh into the gluteal region. These compartments contain muscles, nerves, and blood vessels.

The lower extremity fascial compartments include three gluteal, three thigh, four calf, and nine of the foot.

Compartment fasciotomy of lower extremity