Fasciotomy

What is a fasciotomy?

A fasciotomy is a surgical procedure to cut through the fascia surrounding a group of muscles to relieve pressure. It’s a treatment for acute compartment syndrome, and it’s usually an emergency procedure.

Fascia is a tough connective tissue that wraps around your muscles and other body parts. A group of muscles, nerves and blood vessels enclosed within a layer of fascia is called a muscle compartment.

When there’s too much swelling inside the compartment, it’s extremely painful and can even cut off blood flow to the tissues, causing them to die. Fasciotomy relieves the pressure and restores blood flow.

Occasionally, fasciotomy also treats chronic compartment syndrome. This is less often an emergency. Chronic compartment syndrome develops more gradually, but sometimes, it gradually becomes severe.

What happens before a fasciotomy?

Fasciotomy is usually an emergency procedure, so you usually won’t prepare for it in advance. Your surgeon will want to operate as soon as they know that you have acute compartment syndrome.

Typically, the diagnosis will happen in the emergency room. They’ll recognize compartment syndrome by the symptoms. It usually happens in your limbs, where the fascia is thicker and more restrictive.

Symptoms include extreme pain, numbness, tingling and decreased pulses in your hands and feet. Once the diagnosis is made, the surgical team will transport you to the operating room for emergency surgery.

You might have an elective fasciotomy if you have chronic compartment syndrome. Healthcare providers only recommend surgery after you’ve tried other treatments, and they haven’t worked.

What happens during the fasciotomy procedure?

You’ll have a fasciotomy under general anesthesia, so you won’t feel or remember it. Your surgeon will:

1. Make an incision (or two) in your skin over the muscle compartment. They’ll identify the fascia and cut through it to release the compartment. They might have to release several compartments.
2. Examine the compartment for damage and remove any dead tissue. They’ll watch to ensure the blood flow returns to your tissues, which will make color return and make them start to swell.
3. Allow the swelling to go down, which can take several days. In some cases, they might apply negative pressure wound therapy to pull some of the fluid from the wound and reduce swelling.
4. Reexamine the wound after a few days and remove additional dead tissue if needed.
5. Close the wound when the swelling has gone down enough. In some cases, they might use a skin graft from somewhere else on your body to close the wound, leaving more space for it.
6. Wrap the wound in a compression bandage. They’ll tell you how long you need to wear it.

How long does a fasciotomy take?

An open fasciotomy may take one to two hours, depending on how complicated your condition is. As acute compartment syndrome often occurs with injury, your surgeon might have to manage that, too.

Is fasciotomy painful?

You might have some pain after the procedure once the anesthesia has worn off. Your provider will prescribe pain medications as needed. Many people manage with over-the-counter medications.

What happens after fasciotomy?

When you’re ready, your healthcare provider will usually recommend physical therapy to help restore your range of motion (how far you can move) in the area. Not moving it enough can make it stiffen.

Does the fascia grow back after fasciotomy?

Fascia does grow back. Ideally, when the incision heals, you’ll have a little more fascia and more room in the compartment. But scarring can make it stiffer, too. This is why physical therapy is important.

What are the benefits of fasciotomy?

Fasciotomy for acute compartment syndrome is often a limb-saving, and sometimes, a life-saving, procedure. It prevents tissue death that could lead to life-threatening infection or limb amputation.

Fasciotomy for chronic compartment syndrome is less dire, but it can relieve chronic pain. Surgeons recommend it when your condition continues to worsen and other treatments aren’t helping enough.

What are the risks or complications of fasciotomy?

Any surgery comes with a small risk of complications like:

• Infection.
• Nerve damage.
• Blood vessel damage.

Additional risks of fasciotomy for acute compartment syndrome include:

• Failure of the procedure to save your tissues, resulting in limb loss.
• Recurrence of compartment syndrome during the healing process.
• Delayed tissue death, requiring another operation to remove it.

Risks of fasciotomy for chronic compartment syndrome include:

• Recurrence. Scar tissue after surgery can tighten the fascia, restricting the muscle compartment. The risk of recurrence is greater if you return to using your muscles too much, too soon.

What is the success rate of fasciotomy?

Acute compartment syndrome usually happens after a severe injury. If you’re in the hospital and you get the diagnosis and the operation in time, it’s almost always successful in saving your affected body part.

The longer you go without treatment, the less successful it’s likely to be. After six hours, you’re at an increased risk of permanent nerve damage. After 12 hours, the rate of complications rises steeply.

Fasciotomy for chronic compartment syndrome is less complicated because you usually aren’t in poor health already when you have the operation. It’s almost always successful in relieving chronic pain.

Chronic compartment syndrome usually happens when you overtrain or overuse your muscles. Athletes and military personnel who return too soon to training may not fully recover or may get it again.

When should I call my healthcare provider?

If you’ve had a recent injury or surgery and you begin to experience symptoms of acute compartment syndrome, it’s very important to seek medical care as soon as possible. Symptoms to notice include:

• Pain that’s out of proportion to the injury.
• Temporary paralysis of a limb.
• Abnormal pain when you stretch a muscle group.
• Numbness, tingling or pins and needles (paresthesia).