Superficial Peroneal Nerve Injury Risk During a Semiblind Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg: An Anatomical and Clinical Study

• Published in: Foot & ankle international Vol. 40; no. 3; pp. 343 - 351
• Main Authors: de Bruijn, Johan A., van Zantvoort, Aniek P. M., Hundscheid, Henricus Pieter Hubert, Hoogeveen, Adwin R., Teijink, Joep A. W., Scheltinga, Marc R.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-03-2019
• Subjects: Aged; Aged, 80 and over; Anterior Compartment Syndrome - surgery; Cadaver; Fasciotomy - adverse effects; Fasciotomy - methods; Female; Humans; Intraoperative Complications; Male; Peroneal Nerve - injuries; fasciotomy; superficial peroneal nerve; CECS; anterior compartment
• ISSN: 1071-1007; 1944-7876
• DOI: 10.1177/1071100718811632

Background:
Up to 8% of patients who underwent a fasciotomy for leg anterior chronic exertional compartment syndrome (ant-CECS) report sensory deficits suggestive of iatrogenic superficial peroneal nerve (SPN) injury. In the current study we aimed to thoroughly assess the risk of SPN injury during a semiblind fasciotomy of the anterior compartment using 2 separate approaches.
Methods:
A modified semiblind fasciotomy of the anterior compartment was performed via a longitudinal 2-cm skin incision 2 cm lateral of the anterior tibial crest halfway along the line fibular head-lateral malleolus both in cadaver legs and in patients with ant-CECS. In the cadaver legs, the skin was removed after the procedure and possible SPN injuries and spatial relationships between the SPN and the opened fascia were studied. Between January 2013 and December 2016, 64 ant-CECS patients who underwent a fasciotomy of the anterior compartment were prospectively followed. Iatrogenic SPN injuries were assessed using questionnaires and physical examinations.
Results:
Macroscopic SPN nerve injury was not observed in any of the 9 cadaver legs. In 8 specimens, the SPN was located at least 5 mm posterolateral to the opened fascia. In 1 specimen, an undamaged SPN branch crossed the operative field in a ventral plane. De novo sensory deficits suggestive for iatrogenic SPN injury were not observed in any of the 64 patients (120 legs; 36 females; median age, 22 years) who underwent a fasciotomy of the anterior compartment.
Conclusion:
The proposed semiblind fasciotomy for treatment of ant-CECS was not associated with SPN injury in either the cadaveric study or our clinical series.
Level of Evidence:
Level IV, case series.