Single incision fasciotomy for acute compartment syndrome of the leg: A systematic review of the literature.

Purpose: To review published literature assessing clinical outcomes and complication rates of single incision fasciotomy in fractures of the lower leg.

Methods: We searched PubMed and EMBASE for articles published through July 5, 2021, using the terms "single incision fasciotomy", "acute compartment syndrome of the limbs", "compartment syndrome fasciotomy", and "(compartment syndrome fasciotomy) AND (incision)". The inclusion criteria were studies of Level I to IV evidence in English, published in 1970 or later, involving human subjects, reporting clinical outcomes of single incision fasciotomy performed in cases of acute compartment syndrome in lower leg fractures, including at least 1 patient.

Results: Among the 3040 combined total results, 11 primary studies met our inclusion criteria. Adequate and safe compartment release was achieved with single-incision technique. No significant difference was found in terms of complications such as infection and non-union.

Conclusions: The comparative efficacy and safety of single-incision fasciotomy is relatively equal to the two-incision techniques when evaluated in the literature. However, double-incision fasciotomy remains the predominant surgical technique, widely preferred by surgeons due to the familiarity with the technique and ease of full compartment release. In addition to the actual fasciotomy procedure, data suggests that operative timing, closure and fixation techniques can significantly impact patient outcomes. These findings may be used to guide the orthopedic community when determining the optimal incision-type to use in acute compartment syndrome emergencies for lower-extremity fracture cases in conjunction with closure and fixation techniques.