Fasciotomy / fasciectomy for chronic exertional compartment syndrome
Pre-Operation
Patients with CECS commonly present with bilateral running-related leg pain. Usually they can start a run pain free, but after a number of minutes or even kilometers, the pain starts to build up. It is usually a tight, cramp like pain, that builds up to the point that running is no longer possible. Once they stop running the pain resolves over a variable period of 20-30 minutes or more. The pain settles completely with rest, but comes back the next time they try running. Other activities, including cycling and swimming are pain free. Some patients give up running and the problem goes away.
The cause of the problem is that the compartments in which the muscles are located, are too tight, and when the blood flow increases to the exercising muscles, the pressure increases to the point that blood can no longer flow into the muscle. This causes oxygen deprivation and hence pain. The non-operative treatment includes stretching work, myofascial releases and other physiotherapy treatments. A heel-striking foot-slapping type running style is associated with the condition and should be corrected with gait analysis and gait re-training.
The pain may be localised to one of the compartments of the leg, often the anterior or front compartment, however it can effect some or all of the leg compartments. However, all compartments of the leg require treatment in most cases.
The diagnosis may be based on clinical features alone, or Dr. Porter may require compartment pressure studies to be performed. This test involves measuring the pressures within each compartment of the leg, before and after exercise has been performed to the point that symptoms are present. If the pressures are significantly increased this confirms the diagnosis.
Other sources of leg pain should be excluded.
If the non-operative measures fail and the patient wants to return to, or continue running, surgical release of the compartments is indicated. The goal of the surgery is to reduce the pressure within the compartments of the leg which is achieved by dividing the lining of each compartment so that it can expand and thus reduce the pressure and allow sufficient blood flow during exercise.
Operation
The operation is performed in an operating theatre with the patient under a general anaesthetic. In most cases Dr. Porter will recommend release of all the compartments, because if only the painful compartments are released, some patients will develop the same problem in the other compartments when they return to running.
In most cases the problem is bilateral. The surgery is performed under the sterile conditions of an operating theatre. The surgical release may be performed using 4 small incision in each leg, or 2 large incisions in each leg. Via the skin incision, the lining of each compartment is released and often a “window” of this tissue removed to reduce the risk of recurrence.
The patient is encouraged to begin exercises to move the muscles in all compartments soon after surgery, to reduce the risk of fibrosis or scarring.