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[Medium Drink Of Water]

Your website says that you do these for your tibia patients:

Peroneal nerve release
Fasciotomy, gastrocnemius open bilateral
Anterior compartment percutaneous fasciotomies

My LL doctor did not do any of them. I did have a fasciotomy for exertional compartment syndrome in my tibialis anterior muscles (more on that below). Now I'm wondering if anything else regarding these three procedures done after the fact would provide any benefit going forward, especially in the long run.

1. Peroneal nerve release: I can do everything in the following video, so I don't think I have drop foot (at least not a severe case) although sometimes working the pedals in my car requires a bit more muscular effort and stretching than I remember needing before. But maybe that's just because the elongated legs are forced into a more awkward angle relative to the pedals. Since getting LL I've had to put the seat of the chair all the way back and the backrest all the way forward in order to be able to drive.



2. Fasciotomy, gastrocnemius open bilateral: From what I've read it appears that this is done to prevent compartment syndrome in the back of the calf. Having experienced confirmed, surgery-warranting exertional compartment syndrome in the tibialis anterior muscles, I'm pretty sure I don't have it in the rear of the leg. Is there any other symptom someone might experience to indicate a potential problem here?

3. Anterior compartment percutaneous fasciotomies: As I was doing my post-frame removal rehabilitation I noticed excessive fatigue in my tibialis anterior muscles casued by just walking. I was diagnosed with exertional compartment syndrome and underwent fasciotomy surgery. There's one scar on each leg, about 2.5 inches long running vertically on the skin covering those muscles. For the previous two procedures, your website mentions specific anatomy to be operated on. I'm wondering if you normally make cuts anywhere else in the anterior of the leg other than the tibialis anterior muscles.

Thank you so much for your contributions to this forum.

[Medium Drink Of Water]

Bump.

[short but sweet]

taken from Dr Paley's CLL FAQ pdf

For tibial lengthening, if the Achilles tendon is too tight, as determined by the Siverskiold test (physical examination),
then a gastro-soleus contracture could result. Gastrosoleus lengthening can be performed but can lead to
permanent weakness of push-off strength. We, therefore, avoid this and prefer limiting the amount of tibial
lengthening to 5cm maximum

If any motor symptoms (weakness or paralysis of muscles) occur, a nerve decompression should be done as soon as possible. This is a small outpatient surgery. In most cases, it is the
peroneal nerve that gets into trouble. It is important that the surgeon know how to decompress this nerve
to prevent foot drop. Delay in decompression can lead to permanent foot drop

I don't think these are done for all patients , more like on a case by case basis
the first rule of medicine is Do no harm , so unnecessary surgeries should be avoided if possible

Dr paley doesn't even do ITB release if you only lengthen 4cm in femur (option 5)

[short but sweet]

I missed some points from Dr paley's pdf when I posted earlier

The pricing for the femur and tibia lengthening includes all additional ancillary procedures such as iliotibial
band (ITB) release and biceps tendon lengthening for femur lengthening and blocking screws if needed
for tibial lengthening, and peroneal nerve decompression for tibia followed by femur lengthening. These
additional procedures are done to PREVENT complications.To reduce pain and to increase the likelihood of
reaching the maximum length with femur plus tibia lengthening, we do a peroneal nerve decompression at
the time of the tibial lengthening.

Prophylactic anterior compartment release may be done at the time of tibial lengthening. This is done to prevent compartment syndrome

[SpeedDialer]

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[Medium Drink Of Water]

bump

[Michael J. Assayag, MD]

bump

thanks for bumping!

It is frequent that I see patients either undergoing tibia lengthening, or post tibia lengthening, with partial numbness at the top of the foot, or other neurapraxia symptoms. Peroneal nerve lengthening prevents that.

Anterior compartment fasciotomy is done to prevent compartment syndrome post op. Very rare, but catastrophic when it happens. Patients hate the aspect it gives their anterior shin in the long run and for that reason, i do not do it often anymore in height lengthening patients.

The hugh gastrocnemius recession is done to allow lengthening without causing ballerina foot (equinus), but It also decreases the risk of abductus of the foot due to excessive stretching of the mid foot . In my experience, a gastrocnemius recession does not cause calf weakness in the long run

i hope this helps!

[1team]

thanks for bumping!

Anterior compartment fasciotomy is done to prevent compartment syndrome post op. Very rare, but catastrophic when it happens. Patients hate the aspect it gives their anterior shin in the long run and for that reason, i do not do it often anymore in height lengthening patients.

The hugh gastrocnemius recession is done to allow lengthening without causing ballerina foot (equinus).

i hope this helps!

What does anterior compartment fasciotomy look like? A couple of users here got it done and I thought it was just a line scar a couple of inches long?

Is gastrocnemius recession the same as strayer release procedure?

[Medium Drink Of Water]

thanks for bumping!Anterior compartment fasciotomy is done to prevent compartment syndrome post op. Very rare, but catastrophic when it happens. Patients hate the aspect it gives their anterior shin in the long run and for that reason, i do not do it often anymore in height lengthening patients.

What are the symptoms of the rare, catastrophic compartment syndrome this is intended to prevent?

[more]

Chances of Sural nerve damage?