PROCEDURE PERFORMED: Four compartment fasciotomy, left leg.
PREOPERATIVE DIAGNOSIS: Compartment syndrome, left leg.
POSTOPERATIVE DIAGNOSIS: Compartment syndrome, left leg.
SURGEON: John Doe, MD
ANESTHESIA: General.
INDICATIONS FOR PROCEDURE: This (XX)-year-old male presented to the ER tonight for evaluation of pain and swelling in the left leg. The problem started today when he first noticed a lump on the inside of his left leg. The pain and swelling progressed through the day. He saw his primary care physician and after that visit the symptoms worsened so he came to the ED. While in the ED, blisters began to form on the leg. The ED physician checked compartment pressures with the Stryker device and found them to be elevated over 100 in two separate areas. Therefore, consent was obtained for surgical decompression of the fascial compartments. The patient’s INR was 2.2 and fresh frozen plasma was ordered.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room. General endotracheal anesthesia was induced. Sterile prep and drape of the left leg were carried out with DuraPrep for four compartment fasciotomy.
We then made a longitudinal incision over the medial aspect of the left leg. We split the skin and subcutaneous tissue and evacuated a large hematoma at that point. We then incised the fascia over the superficial posterior compartment. Once this was decompressed, we palpated the posterior aspect of the tibial border. We incised the fascia at that location. A Kelly clamp was inserted into the deep space and gently spread longitudinally. We palpated the compartments to confirm that they were decompressed.
We then performed release of the lateral and anterior compartments through a common anterolateral incision. Through this incision, we identified the anterior and lateral compartments. We incised the fascia longitudinally. We then returned to the medial compartment where bleeding was noted. We held pressure and this controlled the bleeding well.
We then identified one significant venous structure that was bleeding. This was cauterized and this controlled the bleeding. We then covered both wounds with Silvadene, Adaptic gauze, and ABD pads. This was wrapped with Kerlix and Ace wrap.
The patient was then revived and taken to the recovery room in stable condition. Pulses were checked with the Doppler intraoperatively and were symmetric between left and right.
