Fasciotomy

clinical exam
intra compartmental pressures >30mmHg
perfusion pressure <30-40mmHg (ie DBP-compartment pressure)

Two incision technique
Anterolateral incision
15cm incision 2cm anterior to fibular shaft over anterior intermuscular septum
transverse incision is made over septum to allow access to both compartments
Visualise septum
identify superficial peroneal nerve near septum
Maintain tension on the fascia with a Kocher clamp
Open the fascia proximally and distally with Mayo scissors
Proximally aim for the patella and distally for the centre of the ankle to stay in the anterior compartment
Avoid straying too medially to avoid injuring dorsalis pedis
Lateral compartment fasciotomy is made in line with fibular shaft
Distally aim for lateral malleolus to stay posterior to the superficial peroneal nerve

Posteromedial incision
Deep and superficial posterior compartments
15cm incision
2cm posterior to edge of tibia
Once down to fascia, undermine to tibial edge: this will avoid long saphenous vein and nerve
Retract saphenous vein and nerve and release fascia over superficial compartment. Keep tension on fascia with a Kocher
Soleus origin is from posterior 1/3 of tib/fib and covers proximal portion of deep compartment
Detach soleal bridge to expose fascia FDL and tibialis posterior
Neurovascular bundle is between tibialis posterior and soleus
In the distal half of the tibia the deep compartment is subcutaneous: again releasing the fascia over FDL is required to access the deep compartment
Fascia is opened distally and proximally under the belly of soleus