Compartments of the Leg

The leg has four osteofascial compartments. The anterior compartment contains tibialis anterior, EHL, EDL and peroneus tertius, with the deep peroneal nerve and anterior tibial artery, and dorsiflexes the ankle - it is the commonest site of compartment syndrome. The lateral compartment contains peroneus longus and brevis with the superficial peroneal nerve and everts the foot. The superficial posterior compartment is the gastrocnemius, soleus and plantaris. The deep posterior compartment contains tibialis posterior, FDL, FHL and popliteus with the tibial nerve and the posterior tibial and peroneal arteries. For acute compartment syndrome I would perform an emergency two-incision four-compartment fasciotomy: an anterolateral incision to release the anterior and lateral compartments (identifying the anterior intermuscular septum and protecting the superficial peroneal nerve distally), and a posteromedial incision to release the superficial and deep posterior compartments, protecting the saphenous vein and nerve and ensuring the deep posterior compartment is fully decompressed. I would leave the wounds open for delayed closure or grafting, and manage rhabdomyolysis.