Calf 2 Incision Fasciotomies -

Procedure

20- to 25-cm incision centered halfway between the fibular shaft & the crest of the tibia
Use subcutaneous dissection for wide exposure of the fascial compartments
Make a transverse incision to expose the lateral intermuscular septum & identify the superficial peroneal nerve just posterior to the septum
Using Metzenbaum scissors, release the anterior compartment proximally & distally in line with the tibialis anterior
Then perform fasciotomy of the lateral compartment proximally & distally in line with the fibular shaft

2 cm posterior to the posterior margin of the tibia
Use wide subcutaneous dissection to allow identification of the fascial planes
Retract the saphenous vein & nerve anteriorly
Make a transverse incision to identify the septum between the deep & superficial posterior compartments
Release the fascia over the gastrocsoleus complex for the length of the compartment
Make another fascial incision over the flexor digitorum longus muscle & release the entire deep posterior compartment
As dissection is carried proximally, if the soleus bridge extends more than halfway down the tibia, release this extended origin.
After release of the posterior compartment, identify the tibialis posterior muscle compartment.
If ↑ tension is evident in this compartment, release it over the extent of the muscle belly
Pack the wound open & apply a posterior plaster splint with the foot plantigrade

primary closure
delayed primary closure
- which can be accomplished using the vessel loop shoelace technique
healing by secondary intention
split-thickness skin grafting to cover defects
- which is necessary in approximately 50% of patients