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Eight cases of the anatomical type of the anterior tibial syndrome are presented, all with vascular obstruction proximal to the anterior tibial artery (iliac artery, femoral artery, and popliteal artery). The syndrome is precipitated by sudden vascular obstruction and runs an acute clinical course, leading to necrosis of the contents of the anterior tibial compartment. The earliest sign is pain and erythema over the anterior tibial compartment when the leg is in the dependent position. In the early stage this redness disappears when the leg is in the horizontal position.Fasciotomy of the anterior crural fascia is advocated to decompress the compartment and thus improve the collateral circulation of the leg. Fasciotomy should be done first and at once; then, the primary vascular obstruction should be sought and climinated. To minimize the risk of infection of the anterior tibial compartment, it is recommended that fasciotomy be done through a very small incision in the skin, approximately one-half of an inch in length, with a special fasciotome designed for the purpose.