Fasciotomy

Fasciotomy is surgery on the fiber-like connective tissue, called fascia, that covers muscles. The procedure reduces the pressure that has built up inside the fascia in a specific area of your body. This is often the lower part of your legs or arms.

This procedure is a recommended treatment for compartment syndrome. This is a condition where pressure has built up inside fascia. This can cause severe pain and swelling. It can be hard to move an arm or leg that is affected. Also, blood flow in that part of the body can become blocked. If compartment syndrome is not treated, nerve damage could result. However, a fasciotomy can relieve the pain and restore blood flow.

Fasciotomy is also used to treat plantar fasciitis. In that condition, fascia on the bottom of the feet has become inflamed (the body's way of reacting to injury or infection). Fasciotomy can be either an emergency or planned procedure.

LET YOUR CAREGIVER KNOW ABOUT:

  • Any allergies.

  • All medicine you are taking, including:

  • Herbs, eyedrops, over-the-counter medicine and creams.

  • Blood thinners (anticoagulants), aspirin or other drugs that could affect blood clotting.

  • Use of steroids (by mouth or as creams).

  • Previous problems with anesthetics, including local anesthetics.

  • Possibility of pregnancy, if this applies.

  • Any history of blood clots.

  • Any history of bleeding or other blood problems.

  • Previous surgery.

  • Smoking history.

  • Other health problems.

RISKS AND COMPLICATIONS

Short-term possibilities include:

  • Excessive bleeding.

  • Pain.

  • Total or partial loss of feeling at the wound site.

  • Hematoma, a pooling of blood in the wound.

  • Infection at the surgery site. If a skin graft is done, the site of the skin that was taken to cover the wound also could become infected.

  • Slow healing.

Longer-term possibilities include:

  • Scarring.

  • Skin damage.

  • A return of the condition that led to fasciotomy.

  • A change in the muscles where the fascia was cut.

  • Damage to blood vessels in the area.

BEFORE THE PROCEDURE

  • Do not use aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief before the surgery. This includes over-the-counter drugs such as ibuprofen and naproxen as well as prescription drugs. Ask your healthcare provider how you might manage pain without increasing surgery risks.

  • Do not take vitamin E for two weeks before the surgery.

  • If you take blood-thinning medicine, ask your healthcare provider about when you should stop taking them.

  • You will be asked to stop eating and drinking fluids about 8 hours before your procedure.

  • You might be asked to shower or wash with a special antibacterial soap before the procedure.

  • Make sure you arrive at least an hour before your procedure, or at whatever time your surgeon recommends. This will give you time to check in and fill out any needed paperwork.

  • If your surgery will be an outpatient procedure, you will be able to go home the same day. Make arrangements in advance for someone to drive you home.

PROCEDURE

The exact procedure will depend on the location of the affected fascia. You will be asleep (under general anesthesia) or just the location near the surgical site will be numbed (regional anesthesia). Ask your surgeon about the details for your procedure.

The area of the fascia will be cleaned and sterilized. The surgeon will make a cut (incision) or several incisions to separate the affected fascia.

  • The wound will then be cleaned and, often, it will then be closed. Stitches might be used to close the wound.

  • Or, the surgeon will use skin stretching devices or skins grafts to close it.

  • Sometimes the wound is not closed immediately. Instead, a dressing is used to keep the wound clean while the area of the fascia heals. The wound is then closed later, either in the surgeon's office or during a follow-up surgery.

AFTER THE PROCEDURE

Sometimes fasciotomy is an outpatient procedure. That means you can go home the same day. Other times it requires an overnight stay in the hospital. Ask your surgeon what will happen in your case.

  • While you are recovering in the clinic or hospital, be sure to tell your caregivers if you are in pain.

  • Before you are sent home, you will be shown how to care for the area around the cut (incision) that was made during surgery.

  • The part of your body where the fasciotomy was done (a foot, for example) may need to be not moved (immobilized) for about 24 hours. Ask your healthcare provider what you should and should not do during this time.

  • Then, you should be able to begin gentle exercises. You will need to return for a follow-up visit to have the dressing changed. At that point, the surgeon will decide whether anything more needs to be done to close any open wounds.

  • Physical or occupational therapy might be recommended. A return to normal functioning could take two to three months.