Fasciotomy
(Compartment Release; Compartment Syndrome Release)
Definition
Fasciotomy is a surgery to relieve swelling and pressure in a compartment of the body. Tissue that surrounds the area is cut open to relieve pressure.
Fasciotomy is most often needed in the leg, but it may also be done in the arm, hand, foot, or abdomen.
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Reasons for Procedure
Muscles, nerves, and blood vessels are separated into areas called compartments. The compartments are wrapped in a strong sheet of tissue called fascia. Fluid buildup or swelling can increase pressure in the compartment. This can slow or block the flow of blood in the area and damages nerves. The loss of blood flow can also cause the death of tissue in the area. The pressure can also painfully squeeze tissue including nerves.
Fasciotomy is used to immediately release the pressure in these compartments. Releasing the pressure will improve blood flow and stop or slow damage to the local tissue. It may be used to treat:
- Acute compartment syndrome —Sudden, dangerous increase in pressure. Often due to trauma or accident.
- Chronic compartment syndrome —Pressure that tends to build slowly and recur. Fasciotomy may be used if other treatments do not work.
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Excessive bleeding
- Infection
- Scarring
- Chronic pain
- Tissue damage that causes loss of nerve or muscle function
- Future corrective surgeries, which may include amputation
- Breakdown of muscle tissue— rhabdomyolysis, which can affect kidney function
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
What to Expect
Prior to Procedure
Acute compartment syndrome and some of its causes are emergency situations. Surgery may need to be done right away to decrease damage.
If it is not a severe emergency, your doctor will examine the affected area thoroughly. Pressure will be measured in each compartment.
Tell your doctor about any medications you are taking, including herbal remedies or supplements.
Anesthesia
You may be given:
- Regional anesthesia —a region of the body is numbed
- General anesthesia —you will be asleep during the procedure
Description of the Procedure
There may be some differences in how a fasciotomy is done based on the part of the body and severity.
In general, the procedure is similar for a leg or arm. One incision will be made in the skin over the compartments. The incision will cover the length of the limb between 2 joints. The fascia, just under the skin, is then cut in the same length. If dead tissue is present it will be removed.
Loose stitching will be placed over the area but the wound will remain open. The doctor will gradually close the wound once the swelling has passed.
Until the wound is closed, the area will be wrapped in a dressing. The wound will be monitored with frequent trips to the operating room to have:
- The dressing removed
- Any additional dead tissue removed
- The wound cleaned
- The stitches tightened to slowly close the area as swelling goes down
- A new dressing applied
Complete closure may take up to 2 weeks. A skin graft may be needed if the area cannot be completely closed.
Immediately After Procedure
You will be taken to the recovery room and monitored.
How Long Will It Take?
The length of the procedure will depend on how much damage there is.
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
You may be in the hospital for up to 3 days. If you have any problems, you may need to stay longer.
Post-procedure Care
At the Hospital
Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Recovery may also include:
- Pain medications
- IV fluids to keep you hydrated
- Urine tests to assess the breakdown of muscle tissue and kidney function
You will also be shown how to use supportive devices like crutches or a sling.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incisions
At Home
You will not be able to use the affected limb. Supportive devices, like a splint or crutches, will be needed to support the limb during recovery.
Call Your Doctor
Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
- Signs of infection, including fever or chills
- Increasing pain that cannot be controlled with the medications you were given
- Increasing swelling that makes the splint and/or dressing tight and painful
- Excessive bleeding that is difficult to stop
- Numbness, tingling, or burning pain
- Loss of feeling or inability to move the affected limb
- You injure the affected limb
- A feeling of tightness or fullness in the area
- Loss of muscle control
- New or unexpected symptoms
If you have signs of acute compartment syndrome or you think you have a different emergency, call for emergency medical services right away.
RESOURCES:
National Institute of Arthritis and Musculoskeletal and Skin Diseases
https://www.niams.nih.gov
Ortho Info—American Academy of Orthopaedic Surgeons
https://orthoinfo.org
CANADIAN RESOURCES:
Canadian Physiotherapy Association
https://physiotherapy.ca
When it Hurts to Move—Canadian Orthopaedic Foundation
http://whenithurtstomove.org
REFERENCES:
Acute compartment syndrome—emergency management. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T909320/Acute-compartment-syndrome-emergency-management. Accessed December 18, 2017.
Acute limb compartment syndrome. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114715/Acute-limb-compartment-syndrome. Updated August 24, 2016. Accessed December 18, 2017.
Bowyer MW. Lower extremity fasciotomy: indications and techniques. Curr Trauma Rep. 2015;1(1):35-44. Available at: http://link.springer.com/article/10.1007/s40719-014-0002-7.
Chandraprakasam T, Kumar RA. Acute compartment syndrome of the forearm and hand. Indian J Plastic Surg. 2011;44(2):212-218.
Mabvuure NT, Malahias M, Hindocha S, Khan W, Juma A. Acute compartment syndrome of the limbs: current concepts and management. Open Orthop J. 2012;6:535-543.
Rao M. Indications and techniques of lower extremity fasciotomy. Case presentation from Kings County Hospital Center. SUNY Downstate Medical Center website. Available at: http://www.downstatesurgery.org/files/cases/indications_techniques_lef.pdf.
Last reviewed November 2018 by EBSCO Medical Review Board Donald W. Buck II, MD Last Updated: 4/07/2017