Fasciotomy and fasciectomy for chronic compartment syndrome

Subcutaneous fasciotomy of the anterior and lateral compartments (pictured on the left) is performed using two transverse skin incisions overlying the intermuscular septum between the anterior and lateral compartments. These incisions are oriented at the proximal and distal ends of the planned fasciotomies in these compartments. Using the two skin incisions, the anterior and lateral compartments are identified and blunt-tipped (Cooley or Metzenbaum) scissors are used to extend the fascial incisions between the two incisions.
Fasciectomy (depicted in the image on the right) is performed through a lateral longitudinal skin incision overlying the intermuscular septum between the anterior and lateral compartments. Using this incision, standard fasciotomies of the anterior and lateral compartments are performed. In addition, a 2 x 6 cm ellipse of fascia is resected ("fasciectomy"), preserving the fascia overlying the intermuscular septum to ensure more complete fascial release for patients with chronic exertional compartment syndrome.