Name of the Procedure:

Decompression Fasciotomy, Leg; Anterior and/or Lateral, and Posterior Compartment(s)

Summary

A decompression fasciotomy is a surgical procedure to relieve pressure within the muscles of the leg. This involves making incisions in the fascia — the connective tissue surrounding the muscle compartments — to release the built-up pressure.

Purpose

The procedure is primarily performed to treat conditions like compartment syndrome, where increased pressure within the muscle compartments impedes blood flow and damages nerves and muscles. The goal is to alleviate pain, restore normal function, and prevent permanent damage to the muscle tissues and nerves.

Indications

• Symptoms of compartment syndrome, such as severe pain, swelling, and decreased sensation in the leg.
• Failure of conservative treatments (rest, ice, compression, elevation) to alleviate symptoms.
• Diagnosed acute compartment syndrome via pressure measurements or clinical assessment.

Preparation

• Patients may be advised to fast for 6-8 hours prior to surgery.
• Medication adjustments, such as discontinuing blood thinners, may be necessary.
• Pre-operative assessments include blood tests, imaging studies (such as MRI or CT scans), and compartment pressure measurements.

Procedure Description

1. Anesthesia is administered, either regional (spinal or epidural) or general anesthesia.
2. Incisions are made in the skin and fascia of the leg, at the affected compartments: anterior, lateral, and/or posterior.
3. The fascia is carefully cut to relieve pressure.
4. Any damaged tissue is repaired or removed.
5. The incisions are closed with sutures or left open and covered with sterile dressings if swelling is a concern.

Duration

The procedure typically takes 1 to 2 hours, depending on the extent of the compartments involved.

Setting

The procedure is performed in a hospital or surgical center, often in an operating room equipped for orthopedic surgeries.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Infection at the incision sites.
• Nerve or blood vessel damage.
• Blood clots.
• Persistent pain or swelling.
• Rarely, recurrence of compartment syndrome.

Benefits

• Alleviation of pain and swelling.
• Restoration of normal leg function.
• Prevention of permanent muscle and nerve damage.
• Improvement typically starts within hours to days following the procedure.

Recovery

• Post-procedure care includes wound management, pain control, and leg elevation to reduce swelling.
• Physical therapy may be recommended to regain strength and function.
• Full recovery can take several weeks to months, depending on the severity of the condition and the patient's overall health.
• Follow-up appointments are essential to monitor healing and address any complications.

Alternatives

• Non-surgical options include pain management, physical therapy, and activity modification, though they are generally less effective for acute compartment syndrome.
• Delayed fasciotomy may be considered if symptoms resolve partially but persist.
• Pros and cons of alternatives vary; non-surgical options are less invasive but may not resolve severe compartment pressure.

Patient Experience

• Patients may experience initial pain and discomfort after the anesthesia wears off, managed with pain medications.
• Swelling and bruising around the incision sites are common.
• Gradual improvement in symptoms can be expected with proper post-operative care and physical therapy.
• Most patients can resume normal activities within a few weeks, with full recovery depending on individual progress.