Ankle and foot fasciotomy: an adjunctive technique to optimize limb salvage after revascularization for acute ischemia.
Some patients with severely ischemic lower limbs continued to have severe ischemic changes in the foot after revascularization procedures and appropriate four leg compartment fasciotomies. Rather than abandon efforts at limb salvage, we performed adjunctive fasciotomies of the ankle and foot in 11 of these patients. These included five cases of acute traumatic superficial femoral or popliteal artery occlusions (three penetrating injuries; two blunt injuries) requiring primary repair or interposition vein graft; three cases of penetrating injury to all infrapopliteal arteries requiring tibiotibial vein bypasses; two cases of iatrogenic thrombosis of the common femoral artery requiring thrombectomy and patch angioplasty; and one case of a traumatically amputated leg requiring replantation. All bypasses remained patent after the distal fasciotomies. Limb salvage and good functional results were achieved in 10 of the 11 patients from 4 to 28 months postoperatively. One patient required a below-knee amputation because of bleeding from an infected graft. Thus fasciotomy of the ankle and foot should be considered during acute revascularizations when a distal bypass occludes without obvious reasons, or when the foot remains ischemic or shows signs of compartment syndrome unrelieved by standard leg fasciotomy.