General Surgery

Fasciotomy, Lower Limb

OPERATION: Four-Compartment Fasciotomy of the Lower Leg
ANAESTHETIC: General / spinal anaesthesia
URGENCY: Emergency
POSITION: Supine

INDICATION:
Compartment syndrome [right / left] lower leg. [Cause: trauma / post-reperfusion / crush injury / vascular procedure]. Compartment pressures measured: [values] / clinical diagnosis based on pain on passive stretch, tense compartments, neurological symptoms.

PROCEDURE:
WHO Checklist performed. Full length of lower leg prepared.

MEDIAL INCISION: Longitudinal incision approximately 2 cm posterior to the medial border of the tibia, extending from 3 cm below the tibial tuberosity to 3 cm above the medial malleolus. Deep posterior compartment opened along full length of incision. Superficial posterior compartment opened.

LATERAL INCISION: Longitudinal incision over the fibula, extending from 2 cm below the fibular head to 2 cm above the lateral malleolus. Anterior compartment opened in full. Lateral (peroneal) compartment opened in full. Peroneal nerve identified and protected.

All four compartments confirmed fully decompressed under direct vision. Muscle viability assessed in each compartment — [viable / non-viable segments noted and managed].

Wound haemostasis. Wounds left open and dressed with [moist dressings / negative pressure wound therapy device].

FINDINGS:
Tense compartments confirmed at surgery. Muscle [pink and viable / pale — [describe any non-viable tissue managed]]. Decompression achieved with muscle bulging confirming adequate release.

EBL: [Volume] ml. COMPLICATIONS: None.

PLANNED RETURN TO THEATRE:
Wound inspection and delayed primary closure / split skin graft at [48–72 hours] once swelling resolved and compartments confirmed viable. Serial debridement if required.