#Fascial compartments of leg thigh skin

Accessory great saphenous veins are frequently present and they run parallel to the GSV both in the thigh and in the leg they lie either anterior, posterior, or superficial to the main trunk.

#Fascial compartments of leg thigh skin

Small superficial veins drain the subpapillary and reticular plexuses of the skin and subcutaneous tissues to form bigger tributaries, which eventually all connect to the saphenous veins.1415 The GSV begins just anterior to the medial ankle, crosses in front of the tibia, and ascends medial to the knee (see Figure 2.8).16-18 Proximal to the knee, the GSV ascends on the medial side of the thigh and enters the fossa ovalis 3 cm inferior and 3 cm lateral to the pubic tubercle.19 The GSV is doubled in the calf in 25% of the population, in the thigh in 8%.20 The saphenous nerve runs in close proximity to the GSV in the distal two-thirds of the calf. Lateral marginal vein into the great (GSV) and small saphenous veins (SSV), respectively. The medial and lateral end of this arch continues through the medial and FIGURE 2.7 Superficial and perforating veins of the foot and ankle. Superficial vein tributaries drain blood into the dorsal venous arch on the dorsum of the foot at the level of the proximal head of the metatarsal bones. The superficial venous system of the foot is divided into the dorsal and plantar subcutaneous venous network (see Figure 2.7). The saphenous compartment is a subcompartment of the superficial compartment. The saphenous fascia is thinner than the deep fascia and it is more pronounced in the upper-mid thigh, than more distally.113 The space between the saphe-nous and muscular deep fascia is the saphenous compartment. The saphenous veins are covered by a fibrous sheath, the saphenous fascia.

Perforating veins pierce through the fascia and connect the superficial to deep veins.12 Communicating veins connect veins within the same compartment: superficial to superficial or deep to deep veins. The fascia surrounding the calf and thigh muscles separates two compartments: the superficial compartment, consisting of all tissues between the skin and the fascia, and the deep compartment, which includes all tissues between the fascia and the bones (see Figure 2.6).11 Superficial veins run in the superfical, deep veins in the deep compartments.

This can help reduce the size of the defect to be covered.Thorough knowledge of the fascial compartments of the leg is a prerequisite of understanding the relationship between superficial and deep veins. Careful use of elastic retention sutures (elastic vessel loop woven through skin staples) can help counteract skin contraction, and be tightened progressively as swelling resolves. This is only permissible if it can be achieved without any skin tension it is inadvisable in smokers, who have impaired capacity for soft-tissue healing.įasciotomy wound edges tend to retract and become difficult to close. It is tempting to the surgeon to try early secondary skin suture, rather than skin-graft coverage, once the swelling has subsided. The simplest and safest technique is to cover the healthy soft-tissue defect with a split skin graft: at a later date, when the limb contours have returned to normal, the grafted area can be excised and secondary skin closure performed without tension. Once any skeletal injury is under control, the fasciotomy wound(s) healthy and the swelling of the soft tissues has sufficiently regressed, consideration must be given to achieving skin coverage. Reperfusion injury is another cause of compartment syndrome. After blood flow is restored, capillaries leak and ischemic muscle swells. An arterial injury may cause compartmental tissue ischemia.Muscle tolerates short periods of hypoxia, but after a few hours, progressive necrosis begins.(MPP has also been called 'Delta P', to indicate the difference between diastolic blood pressure and intramuscular pressure.) This difference in pressure reflects tissue perfusion far more reliably than the absolute intramuscular pressure. The critical measurement is muscle perfusion pressure (MPP), the difference between diastolic blood pressure (dBP) and measured intramuscular tissue pressure.

if diastolic arterial pressure is not more than 30 mm Hg above tissue pressure, compartmental capillary blood flow is significantly obstructed and severe hypoxia occurs in muscle and nerve tissue.When tissue pressure approaches the diastolic pressure, capillary blood flow ceases. The capillary filling pressure is essentially diastolic arterial pressure. This critical level is the tissue pressure which collapses the capillary bed and prevents low-pressure blood flow through the capillaries and into the venous drainage. Compartment syndrome occurs when the pressure within a closed osteo-fascial muscle compartment rises above a critical level.