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Minimally Invasive Lower Leg Fasciotomy for Chronic Exertional Compartment Syndrome—How Safe Is It? A Cadaveric Study
BACKGROUND: Chronic exertional compartment syndrome (CECS) is a recognized clinical diagnosis in running athletes and military recruits. Minimally invasive fasciotomy techniques have become increasingly popular, but with varied results and small case numbers. Although decompression of the anterior a...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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SAGE Publications
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536378/ https://www.ncbi.nlm.nih.gov/pubmed/33062761 http://dx.doi.org/10.1177/2325967120956924 |
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author | Grechenig, Peter Valsamis, Epaminondas Markos Müller, Tom Gänsslen, Axel Hohenberger, Gloria |
author_facet | Grechenig, Peter Valsamis, Epaminondas Markos Müller, Tom Gänsslen, Axel Hohenberger, Gloria |
author_sort | Grechenig, Peter |
collection | PubMed |
description | BACKGROUND: Chronic exertional compartment syndrome (CECS) is a recognized clinical diagnosis in running athletes and military recruits. Minimally invasive fasciotomy techniques have become increasingly popular, but with varied results and small case numbers. Although decompression of the anterior and peroneal compartments has demonstrated a low rate of iatrogenic injury, little is known about the safety of decompressing the deep posterior compartment. PURPOSE: To evaluate the risk of iatrogenic injury when using minimally invasive techniques to decompress the anterior, peroneal, and deep posterior compartments of the lower leg. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 60 lower extremities from 30 adult cadavers were subject to fasciotomy of the anterior, peroneal, and deep posterior compartments using a minimally invasive technique. Two common variations in surgical technique were employed to decompress each compartment. Anatomical dissection was subsequently carried out to identify incomplete division of the fascia, muscle injury, neurovascular injury, and the anatomical relationship of key neurovascular structures to the incisions. RESULTS: Release of the anterior and peroneal compartments was successful in all but 2 specimens. There was no injury to the superficial peroneal nerve or any vessel in any specimen. A transverse incision crossing the anterior intermuscular septum resulted in muscle injury in 20% of the cases. Release of the deep posterior compartment was successful in all but 1 specimen when a longitudinal skin incision was used, without injury to neurovascular structures. Compared with a longitudinal incision, a transverse skin incision resulted in fewer complete releases of the deep posterior compartment and a significantly higher rate of injury to the saphenous nerve (16.7%; P = .052) and long saphenous vein (23.3%; P = .011). CONCLUSION: Minimally invasive fasciotomy of the anterior, peroneal, and deep posterior compartments using longitudinal incisions had a low rate of iatrogenic injury in a cadaveric model. Complete compartment release was achieved in 97% to 100% of specimens when employing this technique. CLINICAL RELEVANCE: Minimally invasive fasciotomy techniques for CECS have become increasingly popular with purported low recurrence rates, improved cosmesis, and faster return to sport. It is important to determine whether this technique is safe, particularly given the variable rates of neurovascular injury reported in the literature. |
format | Online Article Text |
id | pubmed-7536378 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-75363782020-10-14 Minimally Invasive Lower Leg Fasciotomy for Chronic Exertional Compartment Syndrome—How Safe Is It? A Cadaveric Study Grechenig, Peter Valsamis, Epaminondas Markos Müller, Tom Gänsslen, Axel Hohenberger, Gloria Orthop J Sports Med Article BACKGROUND: Chronic exertional compartment syndrome (CECS) is a recognized clinical diagnosis in running athletes and military recruits. Minimally invasive fasciotomy techniques have become increasingly popular, but with varied results and small case numbers. Although decompression of the anterior and peroneal compartments has demonstrated a low rate of iatrogenic injury, little is known about the safety of decompressing the deep posterior compartment. PURPOSE: To evaluate the risk of iatrogenic injury when using minimally invasive techniques to decompress the anterior, peroneal, and deep posterior compartments of the lower leg. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 60 lower extremities from 30 adult cadavers were subject to fasciotomy of the anterior, peroneal, and deep posterior compartments using a minimally invasive technique. Two common variations in surgical technique were employed to decompress each compartment. Anatomical dissection was subsequently carried out to identify incomplete division of the fascia, muscle injury, neurovascular injury, and the anatomical relationship of key neurovascular structures to the incisions. RESULTS: Release of the anterior and peroneal compartments was successful in all but 2 specimens. There was no injury to the superficial peroneal nerve or any vessel in any specimen. A transverse incision crossing the anterior intermuscular septum resulted in muscle injury in 20% of the cases. Release of the deep posterior compartment was successful in all but 1 specimen when a longitudinal skin incision was used, without injury to neurovascular structures. Compared with a longitudinal incision, a transverse skin incision resulted in fewer complete releases of the deep posterior compartment and a significantly higher rate of injury to the saphenous nerve (16.7%; P = .052) and long saphenous vein (23.3%; P = .011). CONCLUSION: Minimally invasive fasciotomy of the anterior, peroneal, and deep posterior compartments using longitudinal incisions had a low rate of iatrogenic injury in a cadaveric model. Complete compartment release was achieved in 97% to 100% of specimens when employing this technique. CLINICAL RELEVANCE: Minimally invasive fasciotomy techniques for CECS have become increasingly popular with purported low recurrence rates, improved cosmesis, and faster return to sport. It is important to determine whether this technique is safe, particularly given the variable rates of neurovascular injury reported in the literature. SAGE Publications 2020-10-02 /pmc/articles/PMC7536378/ /pubmed/33062761 http://dx.doi.org/10.1177/2325967120956924 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Article Grechenig, Peter Valsamis, Epaminondas Markos Müller, Tom Gänsslen, Axel Hohenberger, Gloria Minimally Invasive Lower Leg Fasciotomy for Chronic Exertional Compartment Syndrome—How Safe Is It? A Cadaveric Study |
title | Minimally Invasive Lower Leg Fasciotomy for Chronic
Exertional Compartment Syndrome—How Safe Is It? A Cadaveric
Study |
title_full | Minimally Invasive Lower Leg Fasciotomy for Chronic
Exertional Compartment Syndrome—How Safe Is It? A Cadaveric
Study |
title_fullStr | Minimally Invasive Lower Leg Fasciotomy for Chronic
Exertional Compartment Syndrome—How Safe Is It? A Cadaveric
Study |
title_full_unstemmed | Minimally Invasive Lower Leg Fasciotomy for Chronic
Exertional Compartment Syndrome—How Safe Is It? A Cadaveric
Study |
title_short | Minimally Invasive Lower Leg Fasciotomy for Chronic
Exertional Compartment Syndrome—How Safe Is It? A Cadaveric
Study |
title_sort | minimally invasive lower leg fasciotomy for chronic
exertional compartment syndrome—how safe is it? a cadaveric
study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536378/ https://www.ncbi.nlm.nih.gov/pubmed/33062761 http://dx.doi.org/10.1177/2325967120956924 |
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