Place the patient supine on the operating table. The use of a tourniquet is clearly contra indicated.
Palpate the tibial tubercle on the anterior aspect of the proximal tibia and the lateral and medial malleoli at the level of the ankle.
Make a longitudinal incision overlying the anterolateral aspect of the lower leg. Begin at the level of the tibial tubercle and extend the incision to end 6 cm above the level of the ankle.
Make a longitudinal incision overlying the posteromedial aspect of the lower leg. Begin at the level of the tibial tubercle and extend the incision distally, ending 6 cm above the ankle.
To decompress the anterior compartments, incise the fascia overlying the anterior compartment in the line of the skin incision. Two separate incisions are required. Ensure that the fascial incision extends the full length of the skin incision.
Next, incise the deep fascia overlying the lateral compartment ensuring the fascial incision extends the full length of the skin incision.
To decompress the superficial and deep flexor compartments, incise the deep fascia in the line with the skin incision to expose the soleus muscle. To decompress the deep flexor compartment, lift the soleus muscle off the intermuscular septum and divide the septum under direct vision, taking care to avoid the posterior neurovascular bundle which lies just beneath it.
The posterior neurovascular bundle is at risk if the fascia covering the deep flexor compartment is not divided carefully.