2/19/2023 0 Comments Four compartments of leg![]() ![]() In the one-incision fasciotomy, the anterior and lateral compartments are released directly. All four compartments of the leg can be released with either a two-incision (medial and lateral) or a one-incision (lateral) fasciotomy. The most commonly performed fasciotomy is that of the leg.Small skin incisions with subcutaneous fasciotomies are not appropriate for acute compartment syndrome. Wherever the location, one or more generous skin incisions should be made and all constricting tissues should be released. Treatment for acute compartment syndrome is surgical release of the involved compartment(s).However, most rely on a clinical diagnosis rather than intracompartmental pressures if the patient is able to cooperate. Fasciotomy has been recommended for compartment pressures greater than 30 mmHg, pressures within 30 mmHg of the diastolic blood pressure, and pressures within 30 mmHg of the mean arterial pressure (MAP). Intracompartmental pressure can be measured with a Stryker needle. Return to sports following surgery is usually 4-6 weeks.Prognosis is excellent if surgery is performed to release the compartment, thus allowing the muscle to expand without any restriction.The athlete usually will need to cease the activity causing the symptoms, which is most likely a running sport. Prognosis for conservative care for extremely elevated compartment pressures is poor.Pressures that are elevated above the threshold that are unrelenting, disallowing an athlete to participate in sports may require a simple fasciotomy to release the compartment and allow full return to all activities.Compartment pressures should be tested to evaluate the pressure relative to the diastolic blood pressure of the athlete.Physical therapy to strengthen weak muscles and stretch tight muscles may provide some limited benefit.Structural abnormalities to the lower extremity may need to be identified and treated with orthotics to lessen stress to the involved area.Activities may need to be modified to work below the threshold of pressure that causes the pain.Identification of this condition is important at the earliest stages.Pain will almost completely resolve once the activity is completely over, only to recur the next day if the activity is resumed.Tingling in the toes and even a footdrop (foot slaps on the ground) may develop during the activity. ![]() ![]() Numbness and tingling develop in the distribution of the nerves that are affected by this condition.The leg will feel firm or even rock hard. Pain and tenseness to the involved compartment.However, will quickly recur once the activity is resumed. The athlete starts to have pain during the activity and with continued activity pain worsens to a point where the athlete cannot continue to walk or run.Pain in the front, side or back part of the leg that occur at a specific time during an activity.Incomplete hernias of muscle through small fascial defects do not allow the pressure in the compartment to lessen.Tight fascial compartments that enclose the muscles.Usually occurs in well-conditioned athletes with low blood pressure.If the compartment that they are in is not able to expand, pain, weakness, numbness and tingling may develop in the front or outer part of the leg. During exercise these muscles may engorge with blood, causing them to enlarge. The muscle in the lower leg is grouped into four compartments. ![]()
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