Fasciotomy techniques for chronic exertional compartment syndrome in the Netherlands

Abstract text (incl. references and figure legends)

Introduction Recently, a new guideline for the treatment of exercise-related leg pain was introduced in the Netherlands. However, consensus on surgical treatment for the chronic exertional compartment syndrome (CECS) is lacking. This qualitative analysis aimed to explore fasciotomy techniques for CECS in the Netherlands.

Material & Methods: Surgeons in the Netherlands who performed at least 5 fasciotomies per year were invited to participate in this study. The Grounded Theory framework was used to iteratively collect and analyze data of semi-structured interviews and perioperative observations.

Results: Interviews with 12 surgeons and 10 perioperative observations were analyzed (Table 1). Three major categories of CECS surgical management were identified (Figure 1). Which compartments a surgeon performed fasciotomies on depended on training and expertise. Most variation was found in fasciotomy technique for the posterior compartment, with minimally invasive versus open techniques reported, via an anterior or posterior approach. A fasciotomy knife was the preferred choice of instrument, but long scissors were also frequently used, especially for the posterior compartment. Standard choice of wound closure was subcuticular, although some surgeons preferred transcutaneous closure to limit wound tension. Fasciotomy techniques for the anterior compartment and post-operative rehabilitation instructions were similar. All surgeons considered suggestive patient history as an important indication for fasciotomy. Initial conservative treatment prior to surgical intervention was reported as essential by some, but not all participants. Moreover, not all surgeons viewed intracompartmental pressure measurement as a key indication for fasciotomy.

Conclusions: Fasciotomy techniques in the Netherlands are primarily based on surgeons' personal opinion and experience. This study provides a basis for the development of national guidelines for fasciotomy approaches for CECS.

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