Seven-Compartment Fascial Release of the Lower Extremity: A Case Report

Abstract

Compartment syndrome of the lower extremities is a condition that can lead to permanent nerve and muscle damage if not treated in an emergent fashion. Fasciotomy of the medial compartment of the thigh is exceedingly rare, and a review of the literature revealed only one reported case where compartment syndrome was present in both the thigh and lower leg compartments simultaneously. Given the rarity of compartment syndrome in all seven compartments of the leg, in this case, we report the development of full leg compartment syndrome in a 29-year-old male who fell asleep on a hard surface for an extended period following heroin intoxication, which was treated with seven compartment fasciotomies. We conclude with a discussion about how medial release of the thigh for compartment syndrome is rare enough that careful consideration of the anatomy must be made before proceeding with the procedure. Additionally, wound closure has many proposed options, but current literature favors skin staples with an interlaced elastic band to minimize delays in wound closure.

Keywords: compartment syndrome; fasciotomy; lower extremity trauma; medial thigh; seven compartment fasciotomy; wound closure.

Figure 1. Axial and coronal computed tomography images of the lower extremities

Axial and coronal computed tomography images of the lower extremities show extensive and diffuse myositis (hypointense signal) (axial A–C, coronal D)

Figure 2. Photographs of the seven completed compartment fasciotomies

(A) A side view of the upper and lower leg fasciotomy incisions, demonstrating bulging and edematous musculature. (B) A side view of the completed fasciotomy incision of the thigh's medial compartment, demonstrating bulging and edematous musculature. (C) A frontal view of the completed fasciotomies with protruding muscles of the leg compartments.