The procedure is tailored to the affected compartment and urgency:

1. Before Surgery Evaluation:
   
   • Diagnosis:
     
     • Clinical assessment: Severe pain, tense swelling, and the “5 Ps” (late signs).
     • Compartment pressure measurement: Using a needle manometer, pressures >30 mmHg (or within 20 mmHg of diastolic BP) confirm ACS.
     • Imaging (X-ray, CT) identifies underlying fractures or injuries.
   • Blood tests assess for rhabdomyolysis (elevated creatine kinase, myoglobin) and kidney function.
   • IV fluids and pain management stabilize the patient.
2. Surgical Techniques:
   
   • Emergency Fasciotomy:
     
     • Performed under general or regional anesthesia (e.g., spinal), lasting 30–60 minutes per limb.
     • The patient is positioned supine or prone, depending on the compartment (e.g., leg, forearm).
     • Lower Leg (Most Common):
       
       • Four compartments (anterior, lateral, superficial posterior, deep posterior) are decompressed via two incisions:
         
         • Lateral incision: Over the fibula, releasing anterior and lateral compartments.
         • Medial incision: 1–2 cm posterior to the tibia, releasing posterior compartments.
       • The fascia is incised longitudinally to relieve pressure, ensuring all compartments are decompressed.
     • Forearm:
       
       • Volar and dorsal incisions release the flexor and extensor compartments.
     • Thigh or Hand: Less common, tailored to affected compartments.
   • Wound Management:
     
     • The skin is left open to prevent pressure buildup; wounds are covered with sterile dressings or a vacuum-assisted closure (VAC) device.
     • Delayed closure or skin grafting is performed 3–7 days later, once swelling subsides and tissues are viable.
   • Additional Procedures:
     
     • Fracture stabilization (e.g., external fixation) or vascular repair (e.g., shunting) may be done simultaneously.
3. After Surgery:
   
   • Patients are monitored in the ward or ICU (if unstable) for 2–5 days.
   • Pain is managed with analgesics (e.g., morphine, NSAIDs); antibiotics prevent infection.
   • The wound is inspected daily for viability; debridement may be needed for necrotic tissue.
   • Delayed closure or skin grafting occurs once swelling resolves.