Limited-incision fasciotomy

surgical fasciotomy, which implies the decompression of the involved muscular compartments to decrease the pressure, is the treatment of choice.

Minimally invasive fasciotomy through a single incision is safe and effective for management of chronic exertional compartment syndrome of the leg, allowing patients to return quickly to sport activities, with high overall satisfaction in the mid-term. The efficacy of fasciotomy as standard management for patients with CECS of the leg is well known

With the patients in supine position and the tourniquet inflated to the tight, the skin was prepared in the usual fashion, and sterile drapes were applied.

A 2.5-cm vertical skin incision was performed over the anterior compartment, at the middle third of the leg, 1.0 cm lateral to the tibial crest. Once the fascia was identified, the skin was retracted, and subcutaneous tissues and layers down to the level of the fascia were carefully dissected with gloved fingers, proximally and distally. If required, to uncover the fascia, the blunt subcutaneous dissection was completed by pushing the closed scissors proximally and distally. In this way, when the deep fascia could be clearly visualized, it was incised with a knife, at an average distance of 1.0 cm from the intermuscular septum (Fig. 1). Under direct vision, the fascia of the anterior compartment was divided proximally and distally, with scissors (Figs. 2, ​,3,3, and ​and4).4). In the same way, when the lateral compartment was also affected, through the same incision, the skin was retracted posteriorly to expose the fascia of the lateral compartment, which was cut. The incision was closed with subcuticular Biosyn suture 3.0 (Tyco Healthcare, Cork, Ireland); steri-strips (3M Health Care, St Paul, MN, USA) were applied for the stab incisions. A Mepore dressing (Molnlycke Health Care, Gothenburg, Sweden) was applied.

Postoperatively, patients were discharged the day of surgery. They were allowed to weight bear as comfortable with elbow crutches and to move the ankle and knee. Patients used crutches for 7 to 10 days after the operation. At 2 weeks, the wounds were inspected, and rehabilitation was started, with gradual return to walking, jogging, and agility training. Competitive training was allowed at 4 weeks, at least; competitive sport was recommended not before than 8 weeks.

Before surgery, 12 of 18 patients were unable to practise any sport activity, the remaining six patients could practise sport activity at lower levels. At the last follow-up, 15 of 18 patients had returned to pre-injury levels of sport, two had gained higher levels of competition compared to the pre-injury status, one had returned to sport at lower level. After surgery, there was a statistically significant increase of the number of patients able to perform sport at pre-injury or higher level (from 0 to 94 %; P < 0.0001), and a statistically significant decrease of the number of patients fully unable to practise any sport (from 67 to 0 %; P < 0.0001) and those able to do sport at reduced levels (from 33 to 6 %; P < 0.0001). The median time to return to competitive training was 8 weeks (range from 4 to 12); the median time to return to competitive sport was 13 weeks (range from 9 to 18). At the last follow-up, the overall satisfaction for the procedure was graded as good in 17 of 18 patients, moderate in one patient.