A fasciotomy surgery is a procedure to cut open the fascia (tissue beneath the skin) to relieve tension or pressure. The muscles in your arms and legs are divided into muscle groups by thick bands of tissue called fascia. The fascia has some openings or compartments that contain muscle tissue, nerves, and blood vessels. Since the fascia is a closed space, whenever there is swelling due to the collection of fluids in the openings or compartments, the fascia is pushed against the muscles, nerves, or blood vessels in the arms and legs. This condition is called compartment syndrome.
The high pressure can damage muscles and nerves and lead to decreased blood flow. Compartment syndromes may develop suddenly (acute compartment syndrome) or gradually over some time (chronic compartment syndrome). In either case, compartment syndrome can lead to severe and permanent damage if left untreated. Emergency fasciotomy is often done for acute compartment syndrome. Compartment syndrome can occur at any site in the body. The leg, however, is most frequently affected. Other sites include the forearm, buttocks, hand, foot, arm, thigh, and back.
Who needs a fasciotomy surgery?
Fasciotomy surgery is done for the treatment of acute compartment syndrome. Untreated compartment syndrome can lead to severe and permanent damage to nerves, blood vessels, muscles, and other structures present in the compartment. When compartment syndrome is diagnosed and treated through a fasciotomy within 6 hours of onset, overall functional impairment is unlikely.
A fasciotomy may be done in patients who may be suspected of having a compartment syndrome. They include a person with:
- A severe injury, such as a car crash
- Badly bruised muscle
- Crush injury
- Tight bandage or cast
- Steroid use
- Symptoms suggestive of compartment syndrome, such as
- Excessive pain
- Pain that becomes severe on muscle stretching
- Pale skin
- Tingling or burning feeling in the skin
- Tightness or fullness in the muscle
- Obvious muscle bulging
- Tightness felt on touching the muscle
A compartment pressure measurement test may be done to determine the pressure within the muscle compartment. If the test shows an increased pressure, an urgent fasciotomy may be done to decompress and save the tissues from further damage.
What are the complications of a fasciotomy surgery?
A fasciotomy surgery is necessary to relieve symptoms and prevent permanent tissue damage in a person with compartment syndrome. The complications of fasciotomy, although rare, may include:
- Excessive bleeding
- Nerve damage
- Muscle damage
- Pruritus (excessive itching)
- Altered sensation such as numbness
- Need for future corrective surgeries, which may include an amputation
- Rhabdomyolysis is a condition that involves the breakdown of muscle tissue, which can cause kidney failure.
Certain health conditions may increase the risk of complications. You must talk to your surgeon, before the procedure, if you have certain disease conditions, such as diabetes, or if you are on any medications, such as steroids, aspirin, or blood thinners. You should also tell your doctor if you smoke or consume alcohol. Obese people may also be at a higher risk of developing complications.
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