Subsequently, the students performed the fasciotomies, where one of them prepared and the other assisted. The procedure was first demonstrated by a highly experienced trauma surgeon using muscle specimen and then demonstrated on two lower extremities, which were assisted by students who worked as anatomical instructors at the Anatomy of Graz. Fasciotomy of the anterior and peroneal compartments was undertaken in all cadaveric specimens. The cadavers were donated to the Medical University of Graz.Įach cadaver was placed in a supine position on a dissection table with support devices beneath both knees. Cadavers with macroscopically obvious pathology of the lower limb were not used. The aim of this study was to evaluate the safety of a two incision minimally invasive fasciotomy with a secure technique to prevent iatrogenic injuries without the use of endoscopy for lower leg CECS when decompressing the anterior and peroneal compartments.Ĥ0 lower extremities from 20 adult human cadavers embalmed with Thiel’s method were used for this study 13. The level at which the SPN pierces the superficial fascia in the lower leg and penetrates into the subcutaneous tissue was on average at 116.8 mm proximal to the lateral malleolus i.e., in 95% of cases the SPN emergence was between 166 and 66 mm proximal to the lateral malleolus 12. 12 evaluated the perforation point of the SPN of the superficial crural fascia. reported a concerningly high risk (67%) for iatrogenic neurovascular damage with minimally invasive fasciotomy without using an endoscope, however the study is limited due to a small number of specimens (n = 6) 11. This discrepancy reflects both the differences in surgical techniques as well as the small number of cases studied, particularly in cadaveric studies 10. The superficial peroneal nerve (SPN) is anatomically closely related to the anterior and peroneal compartments, with the rate of reported iatrogenic SPN injuries varying between 0–8% 7, 10. The risk of neurovascular injury is a major surgical problem in the application of minimally invasive fasciotomies. The literature heavily focused on techniques for decompression of the anterior compartment, as it is assumed that the anterior compartment of the leg is most frequently affected 9, 10. This is because they have shown low recurrence rates and allow a faster return to sports activities 7, 8. Minimally invasive techniques are gaining popularity. Success rates for these procedures are between 52 and 100% 4, 5, 6. The literature varies widely on postoperative outcomes for fasciotomies in CECS but are acceptable. The treatment of choice, after failed conservative management, is surgical fasciotomy 3. Furthermore, the longer decompression is delayed, the greater will be the degree of functional loss 1.Ī rare but accepted clinical diagnosis in runners and military recruits is a chronic exertional compartment syndrome (CECS) 2. Surgical decompression of the lower leg for acute compartment syndrome is the only reliable way to prevent the late sequelae of ischemic contracture if it is done in time. Two incision minimally invasive fasciotomy to decompress the anterior and peroneal compartments of the lower leg appears to be safe with regard to the results of this study. More precisely, in these cases the medial dorsal cutaneous nerve got injured during the fascial opening of the extensor compartment. Two nerve injuries of the superficial peroneal nerve were reported. Release of the anterior and peroneal compartments was successful in all specimens. The second incision was made at the mid-point of the Fibula (half-way between the fibular head and the lateral malleolus). The first incision was made 12 cm proximal to the lateral malleolus to identify and protect the superficial peroneal nerve (SPN). Forty lower extremities from 20 adult cadavers, embalmed with Thiel’s method, were subject to fasciotomy of the anterior and peroneal compartment using a dual-incision minimally invasive fasciotomy. To evaluate the risk of iatrogenic injury when using a dual-incision minimally invasive technique to decompress the anterior and peroneal compartments of the lower leg.
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