The aim of this study is to systematically review the literature on clinical outcomes and complications of single-incision fasciotomy in leg fractures. To date, no systematic review has been completed on the efficacy and safety of single-incision fasciotomy in fractures of the leg. This could lead to potentially devastating outcome if the affected compartment isn't adequately released. 4 One of the major concerns for single-incision fasciotomy is an incomplete decompression of the affected compartments in particular the posterior and posterior deep compartment. Although two-incision technique is the most commonly used technique, single incision fasciotomy is recommended by some authors for maintaining stability of fractures and minimizing additional soft tissue trauma. Lower limb fasciotomies are usually performed, often with either a single lateral incision, or by using two incisions, anterolaterally to decompress the anterior and lateral components and posteromedially for the release of the deep and superficial compartments. To treat ACS of the lower leg, many authors recommend a procedure that allows for the decompression of all four compartments (anterior, lateral, deep posterior, and superficial posterior). Major indicators of compartment syndrome include pain out of proportion, pain upon passive stretching of muscle, and elevated pressure within a compartment.3, 13Īn emergency fasciotomy is performed to relieve the area of high compartment pressure and reduce the risk of ischemia. 1 In many cases, it can be a challenge to properly manage this condition in a timely manner since the diagnosis of acute compartment syndrome is largely clinical. 2 Therefore, an early diagnosis and aggressive treatment are essential in preventing significant long-lasting effects that can dramatically alter a patient's quality of life. The nerves are delicate, much more fragile compared to the muscles and sensitive to elevated conditions, and can be affected by just 4 h of exposure to elevated compartment pressures. Some of the more common effects of surgical intervention to ACS includes lingering disability when major structures are injured during acute compartment syndrome episode or during the actual surgical intervention itself. The most serious outcomes of delayed intervention or untreated compartment syndrome include limb amputation and death, therefore, it is imperative that the condition is recognized and treated as soon as possible. Acute compartment syndromes commonly occur in the extremities, especially the tibia or forearm. Additionally, compartment syndromes can be categorized into either acute or chronic stages but acute compartment syndrome was the focus of this literature review. Expansion of contents or decrease in compartment volumes, usually from surgical closure or tissue defects, are common causes of elevated compartment pressures. 1 The limited blood flow to muscles and nerves contained within that compartment, which is covered by a membranous fascia, leads to tissue ischemia and necrosis, since the living tissue is unable to receive sufficient oxygen, resulting in cell death. The tissue pressure in a fascial compartment increases to such an extent that the local arteriovenous pressure gradient drops inducing blood stasis. Acute compartment syndrome (ACS) is a medical emergency that normally occurs after major trauma, such as fractures, or vascular injury to an extremity.
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