Modified mini-open technique with skin transillumination for decompression fasciotomy in the treatment of chronic exertional compartment syndrome

Fasciotomy for chronic exertional compartment syndrome can be achieved by a variety of methods, many of which involve the blind passage of scissors or a fasciotome to release the affected compartments. We describe a modified open technique of fasciotomy which provides direct visualization of the fascia and the superficial peroneal nerve, using a single small incision. This technique requires a 4-cm longitudinal incision centered at the midpoint of the fibula. Subcutaneous tissues are dissected and a fascial incision is made. Langenbach retractors are used to lift the skin from either end of the wound. A light is used to transilluminate the skin proximal and then distal to the wound, and a fasciotome is used to extend the fasciotomies for both anterior and lateral compartments. Fasciotomy using this method was carried out on 20 cadaveric legs from 10 specimens. After decompression, a fulllength skin incision was made and the subcutaneous tissues were dissected to assess adequacy of release, anatomic course of the superficial peroneal nerve and complications. Fasciotomy was completed in twenty legs for both the anterior and lateral compartments. A complete fascial release was attained for both compartments in all legs. There were no retained fascial bands or nerve injuries. Fasciotomy using this method may be a safe and reliable method for compartment decompression, and may reduce iatrogenic risk to neurovascular and muscular structures in clinical practice.