Fasciotomy: Surgery, Indications Incision, Procedure

Fasciotomy is a surgical procedure to reduce swelling and pressure in any part of the body.

The tissue surrounding the area is cut to relieve pressure.

Fasciotomy is mostly applied to the leg in the medical world, but it can also be performed on the hand, arm, foot or abdomen.

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Why Is Fasciotomy Surgery Performed?

Blood vessels, nerves, and muscles are divided into areas called compartments.

These compartments are wrapped in a strong layer of tissue throughout the body called fascia.

Fluid buildup or swelling in these sections increases pressure and slows or completely blocks blood flow in the area. This sometimes results in nerve damage.

In addition, blood loss in the body area as a result of blood flow can cause tissue death.

Another risk is that the pressure risks compressing tissues, including nerves, painfully.

The fasciotomy procedure is used to immediately relieve the pressure in such areas of the body.

Fasciotomy surgery provides relief to the patient by releasing pressure, improving blood flow, and preventing or slowing damage to local tissue.

The fasciotomy procedure is generally used in the treatment of the diseases listed below:

  • Chronic compartment syndrome – This syndrome is a pressure that builds up slowly and tends to recur. Fasciotomy may be considered if other treatments fail to produce good results.
  • Acute compartment syndrome – In this syndrome, there is a sudden dangerous increase in pressure in the affected area due to trauma or accident. Fasciotomy surgery may be considered in such severe cases.

Possible Complications

Fasciotomy is generally safe and problems are rare, but it should be noted that all procedures carry some risks.

After the procedure, your doctor will review possible problems such as:

  • Tissue damage that causes loss of muscle or nerve function
  • Future corrective surgeries, which may include amputation (cutting out all or part of a protrusion-shaped organ).
  • Deterioration of muscle tissue.
  • Infection
  • Scar
  • Chronic pain
  • Excessive bleeding

If you have any of the following conditions prior to this procedure, be sure to discuss this with your doctor as it can increase your risk of complications:

  • If you are a smoker
  • If you are using any alcoholic beverage
  • If you have chronic diseases such as obesity or diabetes

Preparation Before Surgery

Acute compartment syndrome and some other causes may require emergency surgery.

To reduce the damage, your doctor may want the surgery to take place without waiting.

Unless it’s a serious emergency, your doctor will thoroughly examine the affected area.

Your doctor will measure the pressure of the affected area in detail.

Be sure to tell your doctor if you are taking prescription or over-the-counter medicines, herbal medicines, or if you have any disease.

How Is Fasciotomy Surgery Done?

Before surgery, the doctor will determine the type of anesthesia based on your condition.

During this surgery, two types of anesthesia can be given to the patient.

  • General anesthesia – General anesthesia is to put the patients to sleep for any painful surgical procedure and to wake them up at the end of the procedure. General anesthesia, similar to a deep sleep state, removes consciousness and pain sensation. General anesthesia is provided by administering drugs through the vein, breathing gas from the lungs or applying both together. At this time, your breathing will be stopped and a tube is placed in the trachea for respiratory support or alternative means are applied. The patient does not remember these procedures. After these procedures, it is allowed to start the operation. After the operation, the administration of drugs other than oxygen is terminated. Medications are given that counteract the effects of some. The tube in the patient’s throat is removed, if it is inserted. The patient is taken to the recovery room for follow-up. The patient is sent to the room where he sleeps after he wakes up and the treatments that will make him feel the least painful are applied.
  • Local anesthesia – of a part of the body; “Regional Anesthesia” is anesthetizing of drugs called local anesthetics (body, waist, arm, leg, chest, etc.) by injecting them with a needle under ultrasound control. There are varieties such as spinal, epidural, nerve block etc. In these types of anesthesia, it can also be done by anesthetizing only the part of the body that will be operated on, without completely anesthetizing the patients (especially the high risk of being fully anesthetized with general anesthesia).

The type of anesthesia will vary depending on the patient’s state of health and severity.

This process is generally similar for arms and legs.

An incision will be made in the skin over the affected area.

The incision that the doctor will make will cover the length of the limb between the 2 joints.

The doctor then cuts the fascia just under the skin to the same length and removes any dead tissue, if any.

Loose stitches are placed on the area after the procedure, but the wound remains open. After the doctor is sure that the swelling is gone, he starts to close the wound gradually.

The surgical area is wrapped with a dressing until it is closed.

Your doctor will monitor you constantly and the following actions will be taken:

  • The dressing will be removed.
  • If there is any additional dead tissue, it will be removed.
  • It will clean the wound.
  • As the swelling decreases, the stitches in the area will be tightened slowly.
  • New dressing will be applied.

It may take up to 2 weeks for the wound to fully close.

If the surgical site is not completely closed, a skin graft (a type of surgical procedure involving a skin transplant) may be required.

After surgery, the patient is taken to the recovery room and closely monitored.

Recovery time varies depending on the patient’s condition.

Does Fasciotomy Surgery Hurt?

Fasciotomy surgery is a painless operation, whether performed under local anesthesia or general anesthesia.

In local anesthesia, the patient does not feel pain because the operated area is completely numb.

In general anesthesia, the patient does not feel any pain because he is completely asleep.

Slight pain may be felt after the procedure, but this pain is eliminated with painkillers.

How Long Does the Patient Stay in the Hospital?

This varies according to the condition of the disease, but usually most patients stay in the hospital for up to 3 days in fasciotomy surgery.

In some cases, your doctor may extend this period.

Hospital Care After Fasciotomy Surgery

After the operation, you will be taken to a special room designed for patients.

In this room, your blood pressure, breathing and heart rate are closely monitored.

The following operations can be applied to you in the room:

  • IV liquids to keep you hydrated
  • Painkillers
  • Urine tests to assess deterioration of kidney functions and blood tissue

Hospital staff will also show you how supportive devices such as slings and crutches work.

Hospital staff will take the following precautions for you to minimize the risk of contracting an infection during your stay in the hospital:

  • Washing hands
  • Wearing a mask or gloves
  • Keeping the surgical area closed.

There are some ways to minimize the risk of infection:

  • Wash your hands frequently and ask this care of your visitors and health care workers as well.
  • Remind healthcare workers to wear masks and gloves.
  • Do not allow anyone, whether a relative or family member, to touch your incisions (operated area).

The operated area should not be used at home.

Supportive devices such as splints or crutches will be needed to relieve the load on the surgical site during recovery.

When Should I Call The Doctor?

If your recovery is not going as your doctor said or if you are starting to experience complications such as the following, contact your doctor without waiting:

  • New or unexpected symptoms
  • Loss of muscle control
  • A feeling of fullness or tightness in the area
  • If injury occurs in the surgical area
  • Loss of feeling or inability to move in the surgical area
  • Signs of infection, including fever or chills
  • Uncontrollable or increasing pain, even with medication
  • Increased swelling that makes the dressing or splint painful and tight.
  • Excessive bleeding that is difficult to stop
  • Numbness, tingling or burning pain

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