The poke test in lower limb fasciotomy: a potentially limb saving technical note

BACKGROUND Delayed or incomplete fasciotomy may result in limb loss or even death in severe polytrauma.1 The angiosomal blood supply of the anterior compartment renders it particularly vulnerable if not correctly decompressed.2 Swelling and local trauma distort anatomy significantly, making it possible to ‘miss’ the intended compartment without some simple means of double-checking. The anterior and lateral compartments may be decompressed via separate fascial incisions through an axial skin incision (running midway between the fibula head and the tibial tuberosity proximally, and the lateral malleolus and the anterior tibia distally).2 Alternatively, the anterior compartment is decompressed via an incision 2cm lateral to the tibial crest. The lateral compartment is then decompressed into the anterior by incising the intermuscular septum, extremely difficult in the presence of severe swelling.3