Fasciotomy: Procedure, Surgery Steps, Risks & Recovery

Fasciotomy is a surgical procedure that involves the deliberate incision or cutting of the fascia. It is a tough, connective tissue that holds muscles, blood vessels and other structures in place. 

The procedure removes increased pressure within a specific compartment in the body. A compartment is a confined space with nerves, muscles, and blood vessels.  

By making controlled incisions in the fascia, fasciotomy expands the affected tissues. This helps relieve pressure, restore blood circulation, and prevent potential damage to muscles and nerves. 

Fasciotomy is a critical intervention to save limbs and preserve overall tissue health. It is an emergency procedure in cases where compartment syndrome threatens tissue function. 

Anatomy and Physiology of the Lower Leg

The most common site of pressure buildup in the muscles is the lower leg. The lower leg, known as the calf, extends from the knee to the ankle. It has two bones, several muscles, and other important structures. 

The two bones include:

1. Tibia (shin bone): It is the longer bone that acts as the weight-bearing bone in the lower leg. 

2. Fibula: Located next to the tibia, it is an attachment for the lower leg muscles. 

The muscles in the lower leg include: 

1. Gastrocnemius: This large muscle is one of the main muscles in the calf. It deals with plantar flexion of the foot (pointing the toes downwards). The gastrocnemius muscle connects to the Achilles tendon by extending down the back of the leg.

2. Soleus: It lies beneath the gastrocnemius. The muscle is also responsible for plantar flexion. The soleus and gastrocnemius muscles help with walking, running, and jumping.

3. Plantaris: The small muscle located in the back of the lower leg. Plantaris is also involved in plantar flexion. 

4. Tibialis Muscles: They are located on the front and back of the lower leg. The tibialis posterior muscle (located at the back) supports the foot’s arch and helps with plantar flexion.  

Other important structures in the lower leg include:

1. Fibular nerves (stimulate the muscles in the front of the lower leg)

2. Tibial nerves (one of the main nerves in the leg; it stimulates the muscles in the back of the lower leg)

3. Achilles tendon (connects a person’s calf muscles to the bones of the foot and ankle)

Fasciotomy is primarily used to treat a medical condition called compartment syndrome. It occurs when pressure within a muscle compartment increases to dangerous levels. Fasciotomy is employed to relieve this pressure and prevent tissue death. Conditions that may be treated with fasciotomy include:

1. Acute Compartment Syndrome: This is the most common reason for performing a fasciotomy. It can arise after trauma, fractures, crush injuries, or surgery. In this condition, the swelling within a muscle compartment leads to restricted blood flow.
   This can threaten tissue function. Fasciotomy surgery for this condition is a medical emergency. 

2. Chronic Compartment Syndrome: This condition occurs in athletes or individuals engaging in repetitive activities. It involves recurrent pain and swelling due to increased pressure within muscle compartments.
   Fasciotomy is rarely required for chronic compartment syndrome. Symptoms can usually be subsided with lifestyle changes. 

Fasciotomy is usually performed for individuals with acute compartment syndrome. Individuals may need a fasciotomy if they develop acute compartment syndrome due to the following conditions: 

1. A fracture

2. Injury that crushes the arm or leg

3. A severely bruised muscle

4. Wearing a tight bandage or cast after injury 

The exact procedure of fasciotomy may vary depending on the location of the compartmental pressure. It takes 45-60 minutes. The general guidelines of the procedure are as follows:

1. Preparation: The patient is made to relax on the operating table. They are positioned on the operating table in a supine position. 

2. IV Line Administration: The team administers an IV line in the patient’s arms or hands for medications and fluids. 

3. Anaesthesia: The patient is given general anaesthesia (putting the patient to sleep) or regional anaesthesia (numbing only the surgical area). 

4. Cleaning the Surgical Site: Someone from the team cleans the surgical area with an antiseptic solution. 

5. Monitoring: The anaesthesiologist monitors the patient’s vitals throughout the procedure. 

6. Incision: Fasciotomy incision depends on the area where the surgery is performed. The surgeon makes one or more incisions in the skin over the affected compartment. The incisions are carefully placed to allow access to the fascia and the muscles underneath.

7. Fascial Release: Using surgical instruments, the surgeon carefully cuts through the fascia that covers the muscles in the affected compartment. They also remove the dead tissue. This release of the tight fascia allows the muscles and tissues to expand, relieving pressure.

8. Closure: The incision is closed once the swelling goes down. Until the wound is closed, the surgical area is covered with a dressing.

Compartment syndrome fasciotomy is usually performed in an emergency. Patients may not get time to prepare for the procedure in such situations. However, when the procedure is planned, doctors may provide several instructions for a smooth surgery. 

Before Surgery 

Before undergoing a fasciotomy procedure, patients can expect several important steps and preparations. These preparations include:

1. Pre-Anaesthetic Checkup: The patient may need a pre-anaesthetic checkup before the procedure. The test assesses the patient’s physical condition and other medical problems.

2. Medical Evaluation: The doctor will conduct a thorough medical evaluation to assess the patient’s health. They will review the patient’s medical history, perform physical examinations, and order relevant tests such as:

1. Blood work

2. Imaging studies

3. Compartment pressure measurements

3. Fasting: The patient will likely be instructed not to eat or drink for a specified period before the surgery. Fasting is required when the procedure involves the use of general anaesthesia. This helps prevent complications related to anaesthesia.

4. Medications: The doctor might guide the patient on the medications they take. Some medications need to be adjusted or temporarily discontinued before the procedure.

5. Arrangements for Aftercare: Patients might need someone to drive them home after the procedure and stay with them for 24 hours. 

6. Discussion: The doctor will briefly explain the surgical procedure, duration, and estimated cost. The patient can ask questions about the procedure. 

On the Day of Surgery

On the day of the fasciotomy procedure, there are several things a patient can expect as they prepare for the surgery. These preparations include:

1. Admission and Formalities: The patient will be admitted to the hospital. They will complete any necessary paperwork and sign consent formalities. 

2. Preoperative Preparation: The nursing team will ask them to change into a hospital gown and remove any piece of jewellery. 

3. Surgical Site Preparation: Someone from the team will shave excess hair from the surgical site. 

4. Medicine Administration: The doctor will record the patient’s last meal and give them a medicine to be taken with a sip of water. 

5. Monitoring of Vitals: The anaesthesiologist will monitor the patient’s vitals, like heart rate, breathing, blood pressure, etc. 

6. Shifting to the OT room: The patient will be shifted to the OT room for the final procedure. 

After a fasciotomy procedure, recovery is crucial for ensuring proper healing and restoring functionality. Patients may need to stay in the hospital for up to three days. Here’s what they can generally expect during the recovery period in hospital and at home:

The Recovery Process in Hospital

The following is what patients can expect in the hospital after surgery:

1. Monitoring: The patient will be shifted to the recovery room as the effects of anaesthesia wear off. An anaesthesiologist will monitor their vital signs and assess their condition.

2. Pain Management: Doctors will prescribe oral painkillers to manage pain and discomfort. 

3. Mobility: The team will gently encourage the patient to move the affected limb. This prevents stiffness and promotes circulation.

4. Closure: The wound will be closed with stitches once the swelling reduces. The surgeon may use a skin graft to cover the area. This happens when the swelling caused by the compartment syndrome is severe. It allows more space in the compartment, decreasing the risk of recurrence.

5. Discharge: The patient will be discharged when their condition stabilises. The doctor will provide several homecare instructions before discharge. 

Recovery Process/Expectation After Hospital Discharge 

The recovery at home after fasciotomy can include the following:

1. Wound Care: Follow the surgeon’s instructions for cleaning and dressing the incisions. Keep the dressings clean and dry. 

2. Medicine: The doctor will prescribe pain medications as needed. Patients should take medicines as directed to manage discomfort. 

3. Activity Restrictions: The affected leg or arm should be kept elevated during the first few days after surgery. Avoid putting excessive weight or strain on the operated limb. Crutches or a walker might be recommended for mobility.

4. Physical Therapy: The patient might be referred to a physical therapist to help regain strength, flexibility, and function in the affected limb.

First Follow-Up Appointment

The first follow-up appointment will be held 6-12 days after fasciotomy. During this appointment, the patients can expect the following:

1. The doctor will check the incision site for healing and examine any complications. 

2. They will remove the stitches or staples used to close the incision. 

3. Once the incision heals, the doctor might refer the patient to a physical therapist.

Patients may need additional follow-up appointments if the surgeon uses a skin graft to close the incision. 

Fasciotomy is a surgical procedure that offers several important benefits. The decision to undergo fasciotomy is made by comparing the benefits and risks of the procedure. Some key benefits of fasciotomy include:

1. Relieves elevated pressure within a muscle compartment

2. Prevents irreversible tissue damage

3. Preserves limb and limb function

4. Provides relief from pain

Risks from fasciotomy are rare. However, like any medical intervention, it has certain risks and complications. The potential risks of fasciotomy include:

1. Infection: Surgical procedures generally carry a risk of infection. Incisions made during fasciotomy can become infected and cause symptoms like:

1. Redness

2. Pain

3. Swelling

4. Discharge from the incision site

5. Fever

2. Bleeding: It can occur during or after the surgery. In some cases, excessive bleeding might require blood transfusions.

3. Scarring: Incisions made during fasciotomy can result in scars. 

4. Chronic Pain and Discomfort: Pain or discomfort can persist after the surgery, particularly if nerve damage occurs during the procedure.

5. Loss of Muscle or Nerve Function: During the procedure, there is a risk of damage to nearby nerves or blood vessels. This can result in numbness, tingling, weakness, or even loss of function in the affected area.

6. Rhabdomyolysis: It is the release of toxic muscle breakdown products into the bloodstream during the procedure. This condition can affect kidney function. 

7. Future Corrective Surgeries: Sometimes, the initial procedure does not fully resolve the underlying issue. It may lead to persistent tissue damage or infection, requiring more extensive intervention like amputation. 

When to Consult a Doctor?

After fasciotomy, patients should consult a doctor if they experience any concerning or unusual symptoms. Patients should call the doctor if they experience the following:

1. Signs of infection like fever and chills

2. Increasing pain that does not get better with medications

3. Excessive bleeding 

4. Increasing swelling 

5. Loss of sensation or immobility of the affected limb

6. Numbness, tingling, or burning

7. A feeling of fullness or tightness in the affected area

8. Loss of muscle control

9. Injury to the affected limb

Delaying a fasciotomy when it is medically indicated can have serious and potentially life-threatening consequences. The risks of delaying fasciotomy surgery include:

1. Tissue Necrosis: Acute compartment syndrome can lead to ischemia (restricted blood and oxygen supply to the tissue) without prompt intervention. This eventually leads to tissue necrosis (tissue death). 

2. Permanent Nerve Injury: Acute compartment syndrome can lead to permanent damage within 24 hours without treatment. This can cause loss of sensation, muscle weakness, or even paralysis.

3. Amputation: In extreme cases where compartment syndrome remains untreated, the risk of amputation of the affected limb can increase. This is especially true if tissue damage is extensive and irreversible.

4. Mortality: Tissue necrosis in delayed fasciotomy can lead to life-threatening complications. 

Cost of Fasciotomy

Generally, the cost of a fasciotomy procedure ranges from ₹ 45,000 to ₹ 90,000. However, the procedure cost can vary significantly depending on several factors. 

Factors that may affect the cost of fasciotomy include:

1. Type of Hospital: Costs may differ between hospitals and outpatient clinics. It may also differ between government and private hospitals. The cost of fasciotomy in government hospitals is less than in private hospitals. 

2. Diagnostic Tests: The cost may include charges for any diagnostic tests, imaging, or consultations performed before or after the procedure.

3. Surgeon’s Fees: The experience and expertise of the surgeon can affect the overall cost. 

4. Hospital Stay: A hospital stay might be required depending on the severity of the procedure and the patient’s condition. Hospital charges can vary depending on the type of hospital, duration of stay, type of room, etc.

5. Post-operative Care: Costs associated with follow-up appointments, physical therapy, medications, and wound care can vary.

6. City or Location: The cost of medical procedures can vary in different cities and locations. Urban areas with higher living costs usually have higher healthcare expenses.

Fasciotomy is a surgical procedure designed to relieve pressure within muscle compartments. Its primary function is to preserve limb function, prevent tissue damage, and, ultimately, save lives. Prompt diagnosis and timely intervention remain essential in harnessing the life-saving benefits of fasciotomy.

The team at HexaHealth offers vital support and information throughout your fasciotomy journey. Our experts provide detailed preoperative guidance, helping you understand the procedure and what to expect. Additionally, we will help you connect with healthcare professionals, allowing for prompt assistance and monitoring. Schedule an appointment today!

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