Nearly half of all service members undergoing fasciotomy reported persistent symptoms, and one in five individuals had unsuccessful surgical treatment. Multivariable analysis confirmed significant associations between surgical failure and perioperative complications (OR, 1.72), activity limitations (OR, 2.23), and persistence of preoperative symptoms (OR, 5.47), whereas other factors were not significantly associated with surgical failure.Ĭhronic exertional compartment syndrome is a substantial contributor to lower-extremity disability in the military population. Univariate analysis of prognostic factors revealed that surgical failure was associated with bilateral involvement (odds ratio, 1.64), perioperative complications (OR, 2.12), activity limitations (OR, 4.41), and persistence of preoperative symptoms (OR, 8.46). Surgical complications were documented for 15.7% of the patients, 5.9% underwent surgical revision, and 17.3% were referred for medical discharge because of chronic exertional compartment syndrome. Symptom recurrence was reported by 44.7% of the patients, and 27.7% were unable to return to full activity. Of the surgical procedures, 77.4% involved only anterior and lateral compartment releases 19.4% addressed the anterior, lateral, and posterior compartments and 2.2% addressed the posterior compartments alone. The average patient age was 28.0 years, and 91.8% of the patients were male. Army Physical Disability Agency database.Ī total of 611 patients underwent 754 surgical procedures. Demographic variables including age, sex, and rank were extracted, and rates of postoperative complications, activity limitations, and revision surgery or medical discharge were obtained from the electronic medical record and U.S. Individuals who had undergone surgical fasciotomy of the anterior, lateral, and/or posterior compartments (current procedural terminology codes 27600, 27601, and 27602) for nontraumatic compartment syndrome of the lower extremity (International Classification of Diseases, Ninth Revision code 729.72) between 20 were identified from the Military Health System Management Analysis and Reporting Tool (M2). We are not aware of any previous study in which the authors rigorously evaluated the rates of return to full activity, persistent disability, and surgical revision after operative management of chronic exertional compartment syndrome of the leg in a large, physically active population. Severe damage to the nerve and blood vessels around a muscle can cause the muscle to die and amputation might be necessary.Chronic exertional compartment syndrome of the leg is a frequent source of lower-extremity pain in military personnel, competitive athletes, and runners. If the pressure becomes great enough, blood flow to the muscle can be blocked, leading to a condition known as compartment syndrome. Blood vessels and nerves can also be affected by the pressure caused by any swelling in the leg. This introduction is followed by a template operative dictation. The text includes an introduction that outlines the indications, risks, alternatives, essential steps, needed equipment, and variations in technique. The thickness of the fascia can give problems when any inflammation present in the leg has little room to expand into. This chapter describes the surgical procedure for two-incision four-compartment lower extremity fasciotomy. Due to the great pressure placed on the leg, from the column of blood from the heart to the feet, the fascia is very thick in order to support the leg muscles. Selective fasciotomy, only opening the compartments with elevated pressure, is a less invasive procedure. It can be performed through either one lateral or a lateral and medial incision. The fascia also separates the skeletal muscles from the subcutaneous tissue. Introduction: The standard treatment for an acute compartment syndrome (ACS) of the lower leg is a four compartment fasciotomy. The septa are formed from the fascia which is made up of a strong type of connective tissue. During a fasciotomy, an incision is made in the fascia. The pressure may be caused by a crush injury, necrotizing fasciitis, or compartment syndrome. Pressure builds under tissue called fascia that covers muscles and organs. Įach compartment contains connective tissue, nerves and blood vessels. A fasciotomy is surgery to relieve pressure that is cutting off blood flow and nerve signals to muscles and tissues. The lower leg is divided into four compartments by the interosseous membrane of the leg, the anterior intermuscular septum, the transverse intermuscular septum and the posterior intermuscular septum. All of the muscles within a compartment will generally be supplied by the same nerve. The compartments usually have nerve and blood supplies separate from their neighbours. The compartments are divided by septa formed from the fascia. The fascial compartments of the leg are the four fascial compartments that separate and contain the muscles of the lower leg (from the knee to the ankle).
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