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Summary

Fasciotomy involves cutting of the fascial tissue (a type of connective tissue) covering a body compartment - a confined space in the body that contains muscles, blood vessels and nerves. The procedure is done to reduce the pressure and swelling inside the operated compartment, generally to treat a painful and potentially fatal condition called compartment syndrome. 

The surgeon may perform this surgery on an emergent basis (for acute compartment syndrome) or plan it ahead and examine the affected area completely (for chronic compartment syndrome). Fasting for up to six hours is required before the procedure, but you will be allowed to drink water. The medical staff will take your signature on a consent form as proof of your permission for this surgery. You will need to revisit the hospital a few days after the procedure to tighten the stitches and cover the area with a new dressing. 

  1. What is fasciotomy?
  2. Why is fasciotomy recommended?
  3. Who can and cannot get fasciotomy?
  4. What preparations are needed before fasciotomy?
  5. How is fasciotomy done?
  6. How to care for yourself after fasciotomy?
  7. What are the possible complications/risks of fasciotomy?
  8. When to follow up with your doctor after a fasciotomy?

Fasciotomy is a surgical procedure that is used to reduce pressure and swelling in a confined space or compartment of the body. A compartment refers to a group of muscles along with nerves and blood vessels, which are covered by a connetive tissue called fascia. Conditions like swelling or fluid buildup in the compartment can increase the pressure within the compartment. This hinders the blood flow to the compartment and decreases the oxygen supply to muscles. As a result, the muscles start dying, and nerves get compressed and damaged. The condition is called compartment syndrome. 

During the surgery, the surgeon cuts the fascial tissues to relieve the pressure inside the compartment. Fasciotomy is usually performed in the leg. However, compartment syndrome in the arm, foot, hand, or abdomen can also be treated through this surgery.

The surgeon may perform this surgery if you have compartment syndrome. There are two types of compartment syndrome:

  • Acute (sudden) compartment syndrome: Acute compartment syndrome can occur suddenly due to a fracture, injury, or an accident. You may experience any of these symptoms during this type of syndrome:

    • Burning or tingling sensation
    • Severe pain, especially when the muscles are stretched 
    • Weakness or numbness in the muscle 
    • Tightness in muscles
    • Tenderness in the affected part
  • Chronic (long-term) compartment syndrome: Chronic compartment syndrome is characterised by reoccurrence of symptoms with gradual increase of pressure in the compartment. This syndrome may show the following symptoms:
  • A tingling sensation 
  • Cramping pain in legs while exercising 
  • Pale and cold feeling in the affected area 
  • Bulging or swelling of the muscle 
  • Difficulty in moving the affected part

There is no specific condition for which this surgery is contraindicated. 

There may be a few conditions in which the procedure may be risky; however, can be performed by taking proper precautionary measures. For example, if the surgeon suspects the occurrence of acute compartment syndrome late, i.e., after 12 hours of the injury, the procedure may cause reperfusion injury (injury caused due to a muscle getting blood supply again after a long time)..

Before this surgery, you will need the following preparation:

  • If you have acute compartment syndrome, this surgery is performed immediately without any delay. However, in the absence of an emergency, the affected part is thoroughly examined. The doctor will even measure the pressure in every compartment using a manometer.
  • Inform your doctor if you are or may be pregnant. Also tell him/her if you have any allergic reaction or medical condition.
  • You may need to abstain from food and drink for at least six hours before the surgery. However, you will be allowed to drink water during this period.
  • You must share information about all the medicines that you take with your doctor. This also includes herbs or supplements.
  • You may be asked to temporarily stop blood-thinning medicines like aspirin, warfarin, or clopidogrel before the surgery.
  • Do not drink alcohol and smoke for a few days before the procedure as they can increase your risk of complications after the surgery.
  • You will have to sign an approval or consent form before the procedure, allowing the surgeon to perform the operation.
  • You will need to arrange someone, a friend or responsible adult, who can take you to and bring you back from the hospital.

Pre-operative preparation

Before conducting this surgery, the medical staff may prepare you for the operation in the following way:

  • You will be asked to wear a hospital gown.
  • You will be placed in a supine (on your back) position on the operation table.
  • An intravenous (IV) line will be inserted in your arm for the administration of anaesthesia.
  • The anaesthetist (a medical professional who gives anaesthesia) will administer general anaesthesia to keep you asleep during the surgery. You may also receive regional anaesthesia to numb the particular part of the body.

During the surgery

The steps for performing the surgery may differ depending on the severity of the condition and the part of the body affected. Generally, the procedure is carried out in the following manner:

  • The surgeon will make an incision (cut) in your skin above the affected compartment. 
  • He/she will cut the fascial tissues in this area to relieve the pressure in the compartment. 
  • The surgeon may also remove dead tissues or muscles at this time.
  • The incision is not sealed to prevent the buildup of pressure again.
  • Instead of placing stitches, the surgeon will wrap the area in a dressing. 
  • Sometimes, the area is loosely stitched to keep it open. 
  • Once the swelling in the compartment goes down, the surgeon will close your incision completely. This may take a few days to weeks. 

The duration of surgery may vary depending on the intensity of the damage to the muscle.

Post-surgery care in the hospital

After the operation, the medical staff will move you to the recovery room. A nurse will monitor your vital parameters like breathing, pulse, and blood pressure during your hospital stay. You will be given the following in the hospital during your recovery:

  • Painkiller medicines 
  • Urine test to evaluate your kidney function and breakdown of muscle tissue 
  • Intravenous fluids for hydration

You will be given a sling or crutches to support your limb after the surgery.

Once you are home, you will need to take the following care:

Wound care:

  • You may be allowed to take a shower. However, bathing in a bathtub is not recommended.
  • Clean your hands properly before wsahing or sanitising the incision. 
  • Avoid applying any creams, ointment, or powder on the wound.
  • Avoid scratching, poking, or rubbing the incision area. 
  • Besides this, you should consume a healthy, balanced diet for better wound healing.

Pain and swelling management:

  • The doctor may prescribe painkillers to reduce your pain after the surgery.

Activities:

  • The physiotherapist will demonstrate some exercises to regain the strength in your limbs. You will need to practise them as indicated.
  • You can resume your office work once your wound is completely healed or when your doctor allows you to. 
  • Resume driving as allowed by the surgeon.

The surgery helps to prevent permanent damage to the muscles by restoring the blood supply.

When to see the doctor?

You must call or visit your doctor immediately if you are experiencing the following symptoms after the surgery:

  • Fever
  • Chills
  • Loss of muscle control
  • Numbness, burning sensation, or tingling at the surgical site
  • Unbearable pain even after taking pain medicines
  • Excessive bleeding
  • Increase in swelling
  • Itching
  • Ulceration 
  • Reopening of the wound
  • Tightness or a feeling of fullness in the operated area

This surgery is known to carry the following complications and risks:

  • Infection 
  • Excessive bleeding
  • Dry and scaly skin 
  • Scarring 
  • Need for amputation
  • Tissue damage
  • Chronic pain
  • Need for skin grafting
  • Swollen limbs
  • Muscle herniation
  • Pruritus
  • Frequent ulceration
  • Tendon tethering
  • Rhabdomyolysis (the breakdown of muscle tissue)

The doctor will give you a follow up date after the surgery, when you will revisit the hospital to get your wounds checked. At the visit, the wound will be cleaned, stitches will be tightened, and a new dressing will be applied. You will need multiple visits until the wound is completely closed.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Beth Israel Lahey Health: Winchester Hospital [Internet]. Winchester. Maryland. US; Fasciotomy
  2. National Health Service [Internet]. UK; Compartment syndrome
  3. Guy's and St. Thomas' Hospital: NHS Foundation Trust [Internet]. National Health Service. UK; Compartment syndrome and fasciotomy
  4. Ormiston RV, Marappa-Ganeshan R. Fasciotomy. [Updated 2020 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan
  5. Hernandez A, Sherwood ER. Anesthesiology principles, pain management, and conscious sedation. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 14.
  6. Vuyk J, Sitsen E, Reekers M. Intravenous anesthetics. In: Miller RD, ed. Miller’s Anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 30.
  7. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Preparing for Surgery: The Operating Room Facebook
  8. Wrightington, Wigan and Leigh Teaching Hospitals [Internet]. NHS Foundation Trust. National Health Service. UK; Dupuytren’s fasciectomy
  9. Cone J, Inaba K. Lower extremity compartment syndrome. Trauma Surg Acute Care Open. 2017;2:e000094.
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