Fasciotomy

Fasciotomy
Other names: Fasciectomy
Once the pressure is reduced, the fasciotomy is covered with a skin graft.
SpecialtyOrthopedics
IndicationsCompartment syndrome

Fasciotomy is a surgical procedure where the fascia is cut to relieve pressure and thus improve circulation to an area of tissue or muscle.[1] It is a limb-saving procedure when used to treat acute compartment syndrome. It is also sometimes used to treat chronic compartment stress syndrome. The procedure has a high rate of success, with the most common problem being accidental damage to a nearby nerve.

Indications

Fasciotomy is used to treat compartment syndrome. Risk factors for developing this condition include:

The procedure may be carried out if:[4]

  • There are strong signs of compartment syndrome
  • Pressures in the compartment are > 30 mmHg (> 20 mmHg if a persons blood pressure is low)
  • There is no arterial blood flow to the area for > 4 hrs

Complications

A delay in performing the procedure can lead to neurovascular complications or lead to the need for amputation of a limb.[1] Complications can also involve the formation of scar tissue after the operation. A thickening of the surgical scars can result in the loss of mobility of the joint involved. This can be addressed through occupational or physical therapy.

Process

A forearm fasciotomy prior to skin grafting.
Wound covered with a skin graft once pressure is relieved.

Fasciotomy in the limbs is usually performed by a surgeon under general or regional anesthesia. An incision is made in the skin, and a small area of fascia is removed where it will best relieve pressure.

Plantar fasciotomy is an endoscopic procedure. The physician makes two small incisions on either side of the heel. An endoscope is inserted in one incision to guide the physician. A tiny knife is inserted in the other. A portion of the fascia near the heel is removed. The incisions are then closed.

In addition to scar formation, there is a possibility that the surgeon may need to use a skin graft to close the wound. Sometimes when closing the fascia again in another surgical procedure, the muscle is still too large to close it completely. A small bulge is visible, but is not harmful. It takes a much longer time to heal and in some cases takes several months.

See also

References

  1. 1 2 Dente CJ, Wyrzykowski AD, Feliciano DV (October 2009). "Fasciotomy". Current Problems in Surgery. 46 (10): 779–839. doi:10.1067/j.cpsurg.2009.04.006. PMID 19735797.
  2. ↑ "Compartment syndrome: MedlinePlus Medical Encyclopedia". Nlm.nih.gov. Archived from the original on 2014-02-20. Retrieved 2014-03-08.
  3. ↑ Lavonas, Eric J; Ruha, Anne-Michelle; Banner, William; Bebarta, Vikhyat; Bernstein, Jeffrey N; Bush, Sean P; Kerns, William P; Richardson, William H; Seifert, Steven A; Tanen, David A; Curry, Steve C; Dart, Richard C (February 3, 2011). "Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop". BMC Emergency Medicine. 11: 2. doi:10.1186/1471-227X-11-2. PMC 3042971. PMID 21291549.
  4. ↑ Long, Brit; Koyfman, Alex; Gottlieb, Michael (April 2019). "Evaluation and Management of Acute Compartment Syndrome in the Emergency Department". The Journal of Emergency Medicine. 56 (4): 386–397. doi:10.1016/j.jemermed.2018.12.021.
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