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

Johan A. de Bruijn; Aniek P. M. van Zantvoort; Henricus Pieter Hubert Hundscheid; Adwin R. Hoogeveen; Joep A. W. Teijink; Marc R. Scheltinga

doi:10.1177/1071100718811632

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

Johan A. de Bruijn^*, Aniek P. M. van Zantvoort, Henricus Pieter Hubert Hundscheid, Adwin R. Hoogeveen, Joep A. W. Teijink, Marc R. Scheltinga

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

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

Original language	English
Pages (from-to)	343-351
Number of pages	9
Journal	Foot & Ankle International
Volume	40
Issue number	3
DOIs	https://doi.org/10.1177/1071100718811632
Publication status	Published - Mar 2019

Keywords

CECS
fasciotomy
anterior compartment
superficial peroneal nerve
ENDOSCOPICALLY ASSISTED FASCIOTOMY
SURGICAL-TREATMENT
FASCIAL HERNIAS
MANAGEMENT
RELEASE
TERM
DIAGNOSIS

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de Bruijn, J. A., van Zantvoort, A. P. M., Hundscheid, H. P. H., Hoogeveen, A. R., Teijink, J. A. W., & Scheltinga, M. R. (2019). Superficial Peroneal Nerve Injury Risk During a Semiblind Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg: An Anatomical and Clinical Study. Foot & Ankle International, 40(3), 343-351. https://doi.org/10.1177/1071100718811632

@article{a83546e2a2f943ddbfae9860a7759fa8,

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

abstract = "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",

keywords = "CECS, fasciotomy, anterior compartment, superficial peroneal nerve, ENDOSCOPICALLY ASSISTED FASCIOTOMY, SURGICAL-TREATMENT, FASCIAL HERNIAS, MANAGEMENT, RELEASE, TERM, DIAGNOSIS",

author = "{de Bruijn}, {Johan A.} and {van Zantvoort}, {Aniek P. M.} and Hundscheid, {Henricus Pieter Hubert} and Hoogeveen, {Adwin R.} and Teijink, {Joep A. W.} and Scheltinga, {Marc R.}",

note = "Funding Information: The Department of Anatomy, Radboud University, Nijmegen, the Netherlands is acknowledged for facilitating the cadaver study. The author(s) received no financial support for the research, authorship, and/or publication of this article. Publisher Copyright: {\textcopyright} The Author(s) 2018.",

year = "2019",

month = mar,

doi = "10.1177/1071100718811632",

language = "English",

volume = "40",

pages = "343--351",

journal = "Foot & Ankle International",

issn = "1071-1007",

publisher = "SAGE Publications Inc.",

number = "3",

}

de Bruijn, JA, van Zantvoort, APM, Hundscheid, HPH, Hoogeveen, AR, Teijink, JAW & Scheltinga, MR 2019, 'Superficial Peroneal Nerve Injury Risk During a Semiblind Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg: An Anatomical and Clinical Study', Foot & Ankle International, vol. 40, no. 3, pp. 343-351. https://doi.org/10.1177/1071100718811632

Superficial Peroneal Nerve Injury Risk During a Semiblind Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg: An Anatomical and Clinical Study. / de Bruijn, Johan A.; van Zantvoort, Aniek P. M.; Hundscheid, Henricus Pieter Hubert et al.
In: Foot & Ankle International, Vol. 40, No. 3, 03.2019, p. 343-351.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Superficial Peroneal Nerve Injury Risk During a Semiblind Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg

T2 - An Anatomical and Clinical Study

AU - de Bruijn, Johan A.

AU - van Zantvoort, Aniek P. M.

AU - Hundscheid, Henricus Pieter Hubert

AU - Hoogeveen, Adwin R.

AU - Teijink, Joep A. W.

AU - Scheltinga, Marc R.

N1 - Funding Information: The Department of Anatomy, Radboud University, Nijmegen, the Netherlands is acknowledged for facilitating the cadaver study. The author(s) received no financial support for the research, authorship, and/or publication of this article. Publisher Copyright: © The Author(s) 2018.

PY - 2019/3

Y1 - 2019/3

N2 - 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

AB - 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

KW - CECS

KW - fasciotomy

KW - anterior compartment

KW - superficial peroneal nerve

KW - ENDOSCOPICALLY ASSISTED FASCIOTOMY

KW - SURGICAL-TREATMENT

KW - FASCIAL HERNIAS

KW - MANAGEMENT

KW - RELEASE

KW - TERM

KW - DIAGNOSIS

U2 - 10.1177/1071100718811632

DO - 10.1177/1071100718811632

M3 - Article

C2 - 30466306

SN - 1071-1007

VL - 40

SP - 343

EP - 351

JO - Foot & Ankle International

JF - Foot & Ankle International

IS - 3

ER -