Prompt diagnosis of fasciotomy is essential to prevent permanent deformity of the extremity or limb loss from delayed treatment. Untreated increased compartment pressure caused by delayed establishment of arterial flow following relief of arterial occlusion or arterial vascular trauma may cause reperfusion injury because of revascularization. Clinical criteria are usually sufficient to make the diagnosis of the compartment syndrome. Pain only proportional to the injury and worsened by dorsiflexion of the ankle is highly suggestive. Two (medial and lateral) longitudinal incisions are used to decompress all four compartments. Fibulectomy is not required to decompress the compartments. Postoperative wound management with frequent debridement of nonviable muscles with change in dressing in the operating room every 24–72 h is required. Patients with open fasciotomy wounds are at risk for infection.