26037 Decompressive fasciotomy, hand (excludes 26035)

Name of the Procedure:

Decompressive Fasciotomy, Hand

Summary

Decompressive fasciotomy of the hand is a surgical operation aimed at relieving pressure within the muscle compartments of the hand. It involves making incisions in the fascia (the connective tissue surrounding muscles) to reduce pressure and prevent damage to muscles and nerves.

Purpose

This procedure addresses compartment syndrome, a condition where increased pressure within a muscle compartment reduces blood flow, compromising the function and viability of muscles and nerves. The goal is to restore normal blood flow and prevent lasting damage to the hand's tissues.

Indications

• Acute compartment syndrome due to trauma, fractures, or crush injuries.
• Chronic compartment syndrome from repetitive use or prolonged exertion.
• Presence of symptoms such as severe pain, swelling, numbness, and weakness in the hand that do not respond to conservative treatments.

Preparation

• Patients may be advised to fast for 6-8 hours before the procedure.
• Medication adjustments may be required, especially if the patient is on blood thinners.
• Preoperative diagnostic tests can include imaging studies (e.g., MRI, CT scan) and compartment pressure measurements.

Procedure Description

1. The patient is typically placed under regional or general anesthesia.
2. The surgeon makes one or more incisions along the hand to access the fascial compartments.
3. The fascia is cut to release pressure.
4. The incisions are either closed or left open with a sterile dressing, depending on the swelling.
5. Postoperative monitoring ensures no complications arise, and the hand's function is gradually restored.

Duration

The procedure typically takes 1-2 hours, depending on the severity of the condition and the number of compartments involved.

Setting

Decompressive fasciotomy for the hand is usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and assistants

Risks and Complications

• Infection
• Bleeding
• Nerve or blood vessel damage
• Poor wound healing or scarring
• Persistent pain or swelling
• Compartment syndrome recurrence

Benefits

• Relief from severe pain and swelling
• Restoration of normal blood flow
• Prevention of long-term damage to muscles and nerves
• Improved hand function

Recovery

• Patients may need to keep the hand elevated and avoid strenuous activities.
• Pain management involves prescribed pain relievers.
• Physical therapy may be recommended to restore strength and movement.
• Full recovery can take several weeks, with follow-up appointments to monitor healing.

Alternatives

• Nonsurgical options such as rest, anti-inflammatory medications, and physical therapy may be considered for chronic cases.
• Surgical alternatives may include more limited decompressions or different surgical approaches depending on the specific circumstances.

Patient Experience

• Patients may experience discomfort and swelling post-procedure, managed with pain medications.
• During recovery, mobility may be limited, and physical therapy can help regain strength and dexterity.
• The overall experience aims to significantly reduce pain and restore function over time.