Fasciotomy or fasciectomy is an emergency limb-saving surgical procedure wherein the fascia is cut open to relieve pressure or tension and swelling in a confined space or compartment of the body due to fluid accumulation. Fascia is a closed space of a multi-layered thick band or sheet of fibrous connective tissue, primarily collagen, that surrounds body parts in the form of some openings or compartments. Whenever there is swelling in the compartments, the fascia is pushed against the muscles, nerves, or blood vessels in the arms and legs, leading to a serious condition called compartment syndrome.
How is fasciotomy performed – Before, during, and after
Before surgery: The presence of compartment syndrome is confirmed through a complete medical history and a physical examination. Once the surgery is finalized, certain confirmatory tests are needed, including blood tests, urine tests, Chest X-ray, ECG, etc. In addition, certain medications that reduce airway secretions before and during surgery may be prescribed to keep the patient calm.
During surgery: The surgery is usually performed under general anesthesia, and the limb where the fasciotomy is planned is prepared and draped properly, and skin is incised to identify the underlying fascia, and an incision is made on the fascia to relieve the pressure. The wound is not sutured but only covered with dressing following fasciotomy.
After surgery: After recovery from the effect of anesthesia, the patient will be encouraged to move from the bed early to prevent deep vein thrombosis. The affected limb is kept elevated for 1-2 days after the surgery. Once the tissue swelling is reduced, focus shifts to wound care.
Cost of Fasciotomy
| Description | Cost |
|---|---|
|
Average Cost of surgery in Hyderabad |
₹ 1,50,00 – 2,50,000 |
|
Average Cost of surgery in India |
₹ 1,00,000 – 5,00,000 |
| Surgery details | Description |
|---|---|
|
Number of days in the hospital |
3 to 5 days |
|
Type of surgery |
Minor to Major |
|
Type of Anaesthesia |
General/ Regional |
|
Number of days required to recover |
Around 2-4 weeks |
|
Duration of the procedure |
20 minutes to 3 hours (depending on severity) |
|
Type of surgical options available |
Minimally invasive |
Risks and complications of fasciotomy
Incomplete or delayed fasciotomies lead to risk factors such as muscle necrosis with severe tissue leading to permanent damage to nerve or muscle function. Long-term risk factors of fasciotomy include chronic limb pain, altered sensation, edema, contracture, muscle herniation, dry skin, pruritus, skin discoloration, venous ulceration, etc. Other complications include extended hospital stay, wound infection and osteomyelitis, need for further surgery for delayed wound closure, delayed bone healing, chronic venous insufficiency, future corrective procedures including amputation, and some cosmetic problems.
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Frequently Asked Questions about Fasciotomy Surgery
Fasciotomy is done based on the mechanism and acuity of the compartment syndrome, whether the surgery would be emergent, urgent, or elective.
Emergent: Patients with acute traumatic compartment syndrome.
Urgent: Patients with delayed or slowly developing secondary compartment syndrome.
Elective: For increased compartment pressures secondary to decreased serum osmolarity or intense exercise.
Recovery from fasciotomy implies controlling discomfort from swelling (0-4 weeks), regaining of muscular strength (5-8 weeks), healing, return of range-of-motion of the ankle joint, and a gradual return to physical activities (9-12 weeks). Physiotherapy post fasciotomy is useful to maximize the success of the surgery, prevent the likelihood of future recurring problems, and ensure complete recovery.
Although full-compartment fasciotomy is undoubtedly the best treatment for acute compartment syndrome, it leaves a large open wound that should be left open for at least 2-5 days. Delayed closure of fasciotomy wounds could lead to an increase in intra-compartmental pressures, and thus, wound closure should be done after five days of fascial release.
Putting full weight on the operative leg is completely allowed after fasciotomy, and walking with two crutches or a walker can be done. However, the patient is advised not to run during the recovery period. Rather a gradual increase in activity in the form of simple ankle and foot up-down movements with heels against the walls can be started off to ensure a safe recovery.
Repeated fasciotomy is needed in conditions like recurrent compartment syndrome. Recurrent compartment syndrome is very rare and reported after trauma in connection with root connective tissue disorders. Patients can be at risk of ischemia-reperfusion injury due to recurrent fasciotomy procedures, although bilateral simultaneous fasciotomies can be done for chronic exertional compartment syndrome.
Generally, the fascia doesn’t grow back to its original configuration after fasciotomy since it is a strong membrane with a lot of tensile strength. However, once the fascia has been divided, the strength never remains the same, and the scar formed at the site of repair usually does not have the tensile strength of the fascia.
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