Fasciotomy is a surgical procedure in which the connective tissue layer under the skin that separates the muscles and internal organs is cut to relieve pressure or tension in a closed space that is causing a loss of blood supply to the tissues. It is most commonly used in the management of acute compartment syndrome.
IS THIS PROCEDURE AN ELECTIVE OR AN EMERGENCY PROCEDURE?
A fasciotomy is usually done as an emergency procedure and is ideally done within 6 hours of the compartment syndrome setting in.
TYPES OF THIS PROCEDURE
Fasciotomy may be done as either of the following
- Double incision fasciotomy – two incisions are used to perform the procedure
- Single incision fasciotomy – a single incision is used to perform the procedure
INDICATIONS
Fasciotomy is indicated for the following
- Acute compartment syndrome – affecting the leg, thigh forearm, hand
- Crush injuries
- Severe burns
- High impact injuries
- Fasciotomy is indicated when the following symptoms are present
- Loss of blood supply
- Extreme pain which is disproportionate to the injury
- Loss of sensation
- Paralysis
- Pain on passive movement or stretching of the affected compartment
CONTRAINDICATIONS & RISK FACTORS
There are no absolute contraindications for performing a fasciotomy
INVESTIGATIONS BEFORE THE PROCEDURE
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PREOPERATIVE ADVICE
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INTRAOPERATIVE DETAILS
Anesthesia: the procedure is usually done under general anesthesia, or sometimes under regional anesthesia
Duration: the procedure can take up to an hour or more to be completed.
Description of the procedure: with the individual lying on their back on the operating table and after the anesthesia has taken effect, the surgical area is prepped and draped in a sterile manner. Depending on the region being operated on either a one or two incisions are given. The skin is dissected to expose the underlying fascia and a small incision (transverse or longitudinal depending on the region of surgery) is given in the fascia usually at the inter-muscular septum. The incision is extended along its length to release the pressure underneath. Appropriate care is taken to not injure the underlying nerves, arteries, and veins.
Delayed skin closure is done after the swelling subsides, and if delayed skin closure cannot be done within 5 days of the surgery, a split thickness skin grafting is done.
POST-OPERATIVE ADVICE
After a fasciotomy the individual is moved to a recovery room and placed under observation and the following are done
- The affected region is kept elevated for 24-48 hours after surgery
- If necrosis of the muscles develops a repeat surgical procedure is done to remove the necrotic muscle
- Proper wound care and management is done
- Intravenous fluids are given Common post procedure complaints
- Pain and discomfort
- Swelling
Medications: analgesics for pain and antibiotics for prevention of infection
Review: is usually within 3-7 days after the procedure
Discharge: depends on the healing of the wound and general condition of the individual
NON MEDICAL – ROLE OF DIET/EXERCISE/LIFESTYLE CHANGES
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COMPLICATIONS
Some complications that are associated with fasciotomy include
- Muscle herniation
- Tendon tethering
- Scarring
- Need for skin grafting
- Ulceration
- Dry scaly skin
- Wound infection
- Altered sensation or loss of sensation
- Amputation if the fasciotomy was not done in time
PROGNOSIS
The prognosis for fasciotomy that is done within 6 hours of setting in of the compartment syndrome is generally good, although it depends on the underlying conditions that needed the procedure in the first place. Delayed fasciotomy is more prone to complications and loss of limb.
WHEN TO CONTACT THE DOCTOR OR HOSPITAL/INDICATIONS FOR HOSPITALIZATION IF REQUIRED
Hospitalization is required for a fasciotomy procedure.
ADDITIONAL INFO
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SUGGESTED CLINICAL SPECIALIST/DEPARTMENTS TO CONSULT FOR THIS PROCEDURE
General Surgery
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