Definition & Overview
Fasciotomy is a surgical procedure used to remove or cut away the fascia to relieve pressure in specific areas of the body.
A fascia is a band of connective tissue that separates muscles and other internal organs. It is composed primarily of collagen and is quite flexible. It serves to reduce friction and provides support and a degree of protection to nerves and blood vessels passing through different muscles and organs. There are different types of fascia all over the body, classified according to their layer, anatomic location, and functions. When pressure builds up in the fascia of internal organs due to disease or injury, it can lead to compartment syndrome, a quite painful and in rare cases, life-threatening condition.
Fasciotomy is the only treatment option for compartment syndrome. In most cases, the procedure is performed immediately after diagnosis to avoid lasting nerve damage and ischemia or the restriction of blood supply to the affected tissue.
Normally performed on the lower parts of the body like the thighs, heels, and legs, fasciotomy is also used to address certain medical conditions like plantar fasciitis. It can also be done on the forearm and hand.
Who Should Undergo and Expected Results
Fasciotomy is for those suffering from advanced plantar fasciitis or severe pain of the heels and soles of the foot usually due to standing up for long periods. It can also be brought about by obesity and wearing improperly fitted shoes. Pain is more severe when the patient gets out of bed in the morning and after resting the feet for a period of time.
Those suffering from compartment syndrome will need to undergo fasciotomy, more so if the condition has reached the acute stage. Athletes are particularly prone to this condition, especially if they are trying to grow muscles in their arms and legs. The fascia in these areas may not expand to accommodate muscle growth, leading to pressure buildup within the fascia compartments. Some sports injuries may also warrant this procedure.
In some cases, emergency fasciotomy is performed on patients who experienced trauma, snake bites, severe burns, and impact injuries. Patients typically experience excruciating pain in the affected area, reduction of blood circulation resulting to pallor and chill, and paralysis.
Fasciotomy has a high success rate, with good outcomes and high satisfaction rating. Patients are able to walk after a few days, although the affected body part may need to be immobilized for a day or two. Physical therapy is often recommended following the procedure to regain muscle function and strength. Athletes may even resume their sports activities after a period of healing. Those suffering from plantar fasciitis report a reduction of pain following the procedure.
How is the Procedure Performed?
Fasciotomy is generally considered a simple surgical procedure. Depending on the location and severity of the condition, patients may be administered with general or local anesthetics. During leg fasciotomy, the surgeon has a choice of making one or two incisions in the affected area. The fascia is then exposed through subcutaneous dissection. The surgeon then proceeds to remove a part of the fascia to relieve pressure on the underlying muscles, nerves, and blood vessels. A similar procedure is also performed on other parts of the body that require relief from pressure.
In the case of plantar fasciotomy, the surgeon makes two incisions and inserts an endoscope to visualize the surgical area. A portion of the fascia near the heel is then removed before the incisions are closed.
Some surgeons may opt to use stitches to close the wound or use skin grafts stretched over the surgical site. In some cases, it is beneficial not to close the wound immediately. A dressing is used to cover the surgical site to allow healing of the fascia. The wound is then closed at a later period.
Possible Risks and Complications
Adverse reactions to anesthesia and bleeding are something to watch out for during fasciotomy. Necrosis or cell death of nearby muscles, which is an indication of damage to the supplying blood vessels, is also another possible risk of the procedure.
As with any surgical procedure, there is always the possibility of developing an infection at the surgical site. In some cases, the anesthesiologist may apply a dose of antibiotics before the surgeon makes an incision to prevent the setting of infection.
Some patients also develop complex regional pain syndrome, typically brought about by damage to the nerves. This is manifested by excessive pain, swelling in the affected area, and fever. This condition is chronic and usually affects the arms, legs, feet, and hands.
Those who have undergone leg fasciotomy face the risk of developing deep vein thrombosis. Patients who are obese, of advanced age, and have a history of heart ailments are particularly predisposed to this condition. Another possible complication to watch out for is pulmonary embolism or blockage in one of the pulmonary arteries in the lungs caused by blood clots traveling from other parts of the body.
Masquelet AC. Acute compartment syndrome of the leg: pressure measurement and fasciotomy. Orthop Traumatol Surg Res. 2010 Dec. 96 (8):913-7.
Arató E, Kürthy M, Sínay L, Kasza G, Menyhei G, Masoud S, et al. Pathology and diagnostic options of lower limb compartment syndrome. Clin Hemorheol Microcirc. 2009. 41 (1):1-8.