Fasciotomy of the lower leg can be done with two incisions, which is the standard technique, or it can be done by a single lateral incision with or without fibulectomy. The single posterolateral incision is different than our incision. Here the incision is made just posterior to the fibula along the lateral border of the gastrocnemius. Our incision is an anterolateral incision that is placed half way between the fibular shaft and the tibial crest. We use the paratibial route from the anterior compartment to release the deep posterior compartment, rather than the transfibular or the parafibular route (from the posterior aspect of the fibula). We use the paratibial route from the anterior compartment to release the deep posterior compartment, rather than the transfibular or the parafibular route (form the posterior aspect of the fibula). Our incision allows for a faster fasciotomy with a small soft tissue wound and avoids potential damage to the neurovascular bundle. Bedside fasciotomy can be done if the patient is sick, if the situation is urgent, or if there is no operating room available for the patient. This is how we do the single incision for fasciotomy of the lower leg. The initial skin incision is made half way between the tibia and the fibula. Release the anterior compartment and the lateral compartment. The superficial posterior compartment is located and released after retracting the peroneal muscles anteriorly. A Cobb or retractor may be used for this purpose. The deep posterior compartment is released by retracting the tibialis anterior muscle laterally from the tibia, then incising the interosseous membrane. When you feel the posterior aspect of the tibia that means that the posterior compartment is released and entered.
