Fasciotomy Surgery in Delhi, India

The muscles of the extremities (arms and legs) are separated into compartments by a thick band of tissue called fascia. Sometimes, crush injuries, infections like necrotizing fasciitis or compartment syndrome build pressure under the fascia. A fasciotomy is performed to relieve the pressure by stopping the blood flow and nerve supply to the muscles and tissues. 

An incision is made in the fascia to relieve the pressure within the muscle compartment, and the built-up fluid is drained and flushed with an antiseptic ointment. Fasciotomy is most commonly done on the arm or leg but can be done on most areas of the body.

When Is Fasciotomy Surgery Needed?

Fasciotomy surgery is recommended for treating acute compartment syndrome. This procedure relieves pressure within the affected muscle groups and prevents its spread. Untreated compartment syndrome can cause severe and permanent damage to adjacent structures such as nerves, muscles, blood vessels, and others. Therefore, within six hours of diagnosis, compartment syndrome should be relieved with fasciotomy to prevent functional impairment.

Diagnosis

A physical exam and the recording of the medical history and symptoms are assessed. To diagnose compartment syndrome, doctors examine the swelling. The doctor looks for signs of differential diagnosis — for example, tendinitis and shin splints.

X-ray: X-rays may be taken to look for any fractures.

Compartment pressure measurement test: It is essential to measure the pressure within the compartment to assist during the procedure. This is done by introducing a needle attached to a machine that gives the pressure reading. 

Pressure test: For diagnosing compartment syndrome, the pressure tests are repeated after exercise, and the before and after results are compared. 

Treatment 

• Doctors first inject anaesthesia, which may be local (only the part to be operated on is numbed) or general anaesthesia (sedation). Then, an IV line for fluids is started. 
• A catheter is placed to monitor vitals such as blood pressure and to take samples of blood. Additional catheters may be attached to monitor the heart into the neck opposite the surgical site.
• Hair at the surgical site is shaved and prepared for incisions.
• A catheter to drain urine is also attached, depending on the area of operation.
• A breathing tube is then placed down the throat to allow adequate breathing and is also connected to a ventilator (depending on the area of operation).
• Antibiotics and electrolytes are given through IV.
• Next, an incision is made over the compartment on the skin, followed by a cut on the fascia beneath the skin. 
• Any dead tissue, if present, is removed, followed by drainage of pus. 
• The area is loosely stitched to keep the wound slightly open. The wound is approximated with sutures once the swelling subsides. The complete closure of the wound may take up to 2 weeks.
• Meanwhile, the dressings are changed regularly, along with cleaning the wound.
• The time taken for the surgery depends on the extent of the damage.
• The stay at the hospital is generally not longer than three days. 

Who is a Candidate for Surgery?

Fasciotomy is performed in patients diagnosed with compartment syndrome. They may be people with:

• A severe injury, such as a car crash
• Badly bruised muscle
• Fracture
• Crush injury
• Tight bandage or cast
• Steroid use
• Symptoms suggestive of compartment syndrome, such as excessive pain.

Who should not Consider Surgery?

Fasciotomy is contraindicated in cases of delayed diagnosis of compartment syndrome. Performing fasciotomy 3-4 days after the onset of compartment syndrome can cause infection and kidney failure in de-vascularized and necrotic muscle settings.

How to Prepare for the Surgery?

Fasciotomy is often performed as an emergency procedure, that is, within six hours of diagnosis, because the pressure builds up suddenly within the muscle compartments. 

If the surgery is planned, Fasciotomy surgeons recommend not eating or drinking at least 12 hours before the surgery. Prophylactic medicines are given before the surgery. Before the procedure, inform the doctor about pre-existing disease conditions like diabetes or any medications, like steroids, aspirin, or blood thinners, and about any allergies. The doctor should also be informed about habits of smoking or consuming alcohol.

Possible Complications

In patients with compartment syndrome, it is essential to lower the built-up pressure to prevent permanent damage to the tissues. Although rare, some complications of fasciotomy include:

• Excessive pain
• Bleeding
• Possible infection
• Scarring of tissue
• Damage to the nerves and muscles
• Pruritus or excessive itching
• Altered sensations such as numbness
• Need for future corrective surgeries such as amputation
• Rhabdomyolysis - involves the breakdown of muscle tissue, which can cause kidney failure.
• Certain health conditions may increase the risk of complications. 

Care after surgery

• Postoperatively, the patient is taken to the recovery room, and their vital signs are monitored. 
• Pain medications and IV fluids are administered. Also, urine tests are taken to assess renal function and the breakdown of muscle tissue.
• To assist with walking, crutches or slings are used.
• To lower the chances of infection, wash hands regularly and don't permit others to touch the wound.
• Inform the doctor in case the following signs are evident:

• Fever or chills
• Infection
• Increase in swelling
• Increased pain
• Excessive bleeding
• Injury to the operated area
• Numbness, tingling, and difficulty moving the operated leg.
• Loss of muscle control
• A feeling of tightness or fullness in the operated area.

Review

Reviewed by Dr. Alok Gupta, Associate Director - Institute of Minimal Access, Laparoscopic & Bariatric Surgery.