Fasciotomy of the Leg

Indications

Foot Compartment Syndrome, fasciotomy for compartment syndrome
Fasciotomy for compartment syndrome. Image by آرمین, Wikimedia Commons, CC BY-SA 3.0.
  • Clinical compartment syndrome
  • Delta pressure (diastolic minus compartment pressure) under 30 mmHg
  • Prophylactic after revascularisation with long ischaemia time
  • Prophylactic fasciotomy after revascularisation of prolonged ischaemia

Position

  • Supine, no tourniquet inflation
  • Tourniquet available but not inflated

Operative Steps

  1. Two incisions, each about 15 to 20 cm
  2. Anterolateral incision 2 cm anterior to the fibula. Identify the intermuscular septum and release anterior and lateral compartments
  3. Protect the superficial peroneal nerve as it pierces the fascia in the distal third
  4. Posteromedial incision 2 cm posterior to the medial tibial border. Protect the saphenous vein and nerve
  5. Release the superficial posterior compartment, then detach soleus from the tibia to open the deep posterior compartment
  6. Check all muscle and debride dead tissue. Leave wounds open
  7. Measure compartment pressures if the diagnosis is uncertain

Postoperative Care

  • Return to theatre at 48 to 72 hours for debridement
  • Delayed primary closure, shoelace technique or split skin graft
  • Stabilise any fracture at the first operation
  • Delayed primary closure or skin grafting at 48 to 72 hours

Complications

  • Missed deep posterior compartment
  • Superficial peroneal and saphenous nerve injury
  • Infection, chronic venous insufficiency, ugly scars
  • Delayed fasciotomy increases infection and amputation

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.