Single incision, minimally invasive fasciotomy of the anterior and lateral leg compartments with decompression of the superficial peroneal nerve. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Symeonidis, Panagiotis D.; Stavrou, Peter
• Is Part Of: Foot and ankle surgery. Volume 28:Issue 1(2022)
• Page Start: 30
• Page End: 36
• Publication Date: 2022-01
• Subjects: Compartment -- Fasciotomy -- Minimally invasive -- Superficial peroneal nerve -- Compression neuropathy -- Chronic exertional compartment syndrome; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; Ankle -- surgery -- Periodicals; Foot -- surgery -- Periodicals; Ankle -- Surgery; Foot -- Surgery; Periodicals; Electronic journals; 617.58
• DOI: 10.1016/j.fas.2021.01.008
• Languages: English
• ISSNs: 1268-7731

Abstract

Highlights: Minimally invasive decompression of anterior and lateral leg compartments through a single incision. Identification and decompression of the superficial peroneal nerve at the same setting in cases with overlapping neuropathic symptoms. Use of a minimally invasive fasciotomy instrument with an integrated light source in order to combine a small incision and safety of the procedure. Abstract: Background: There is a considerable overlap of symptoms between chronic exertional compartment syndrome (CECS) of the anterior and lateral compartments of the lower leg and entrapment neuropathy of the superficial peroneal nerve (SPN). We describe a minimally invasive, single incision surgical technique for release of both the compartments and the SPN in the same setting. The operative technique involves a minimal anterolateral approach at the level where the SPN pierces the subcutaneous fascia. Methods: Nineteen patients were operated with the method and 24 anterolateral compartments (5 cases with bilateral CECS) were released. Anterior and lateral, proximal and distal fasciotomies were performed sequentially with the use of a specific instrument designed for carpal tunnel release (KnifeLight®, Stryker). This is a modification of a fasciotome with an intergrated light source which allows for transillumination of the subcutaneous tissues. The SPN and its main branches with their anatomical variations were explored and decompressed at the same setting. Results: Patients who met the inclusion criteria were reviewed at one year postoperatively with a Numeric Analog Pain Scale (NAS) and the Linkert satisfaction scale. There were 5 men and 10 women, aged 35.7 (21–60) years. The NAS scores improved by a mean 6 points ( p < 0.0001) postoperatively and 86.6% (13/15) of the patients were either satisfied or very satisfied with the operation. There were no intraoperative complications. There were two patients with SPN neuropathy symptoms postoperatively, one of whom required revision surgery. One patient had recurrence of less intense symptoms in the first postoperative year with no need for reoperation. Conclusions: The simultaneous release of the anterolateral compartment of the leg and decompression of the SPN with the described technique was safe and effective. It combined the advantages of a single, minimally invasive approach with the subcutaneous transillumination, and had a high patient satisfaction and a low recurrence rate. Level of evidence: Retrospective case series, Level IV.