27892 Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable muscle and/or nerve

Name of the Procedure:

Decompression Fasciotomy, Leg; Anterior and/or Lateral Compartments Only, with Debridement of Nonviable Muscle and/or Nerve

Summary

A decompression fasciotomy is a surgical procedure performed to relieve pressure in the leg's anterior and/or lateral compartments, where muscles, blood vessels, and nerves are located. The procedure involves the surgical cutting of the fascia (a thick layer of tissue) to relieve pressure and includes the removal of dead muscle and/or nerve tissue.

Purpose

This procedure addresses compartment syndrome, a condition where increased pressure within a muscle compartment reduces blood flow and can cause muscle and nerve damage. The goals of the procedure are to alleviate pain, restore blood flow, prevent further tissue damage, and promote healing.

Indications

• Acute compartment syndrome due to trauma, fractures, or vascular injuries.
• Chronic exertional compartment syndrome experienced during exercise.
• Symptoms such as severe pain, numbness, muscle weakness, or decreased pulse in the affected leg.

Preparation

• Fasting for at least 8 hours before the procedure if general anesthesia is used.
• Stopping certain medications like blood thinners, as advised by the doctor.
• Pre-operative imaging or diagnostic tests such as MRI or compartment pressure measurements.

Procedure Description

1. Anesthesia: The patient is given general or regional anesthesia.
2. Incision: A long cut is made along the affected compartment(s) of the leg.
3. Fasciotomy: The fascia is cut to relieve pressure within the muscle compartment.
4. Debridement: Removal of any nonviable (dead) muscle or nerve tissue.
5. Closure: The incision is closed loosely or left partially open to allow for swelling, using skin sutures or a device like a vacuum dressing.
6. Drainage: Placement of drains may be used to prevent fluid buildup.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon or vascular surgeon.
• Anesthesiologist.
• Surgical nurses.
• Assistive personnel such as surgical technologists.

Risks and Complications

• Infection.
• Blood clots.
• Nerve damage.
• Delayed wound healing.
• Recurrence of compartment syndrome.

• Scarring and reduced muscle function.

  Benefits

• Relief from severe pain and swelling.
• Restoration of normal blood flow and muscle function.
• Prevention of severe complications such as permanent tissue damage and loss of limb function. Patients often begin to notice benefits within days, though complete recovery may take several weeks.

Recovery

• Pain management with prescribed medications.
• Keeping the leg elevated to reduce swelling.
• Following wound care instructions for any incisions or dressings.
• Gradual return to activities as advised by the doctor.
• Physical therapy may be recommended to restore strength and mobility.
• Follow-up appointments to monitor healing and discuss any complications.

Alternatives

• Non-surgical management for mild cases, including rest, anti-inflammatory medications, and physical therapy.
• Other surgical options such as delayed primary closure or skin grafts, depending on the severity of tissue damage.
• Each alternative has its benefits and drawbacks, which should be discussed with your healthcare provider.

Patient Experience

• During the procedure, the patient will be under anesthesia, so they will feel no pain.
• Post-operatively, patients may experience pain, which can be managed with medications.
• Common feelings include discomfort around the incision site and swelling.
• Measures like ice packs, compression garments, and proper leg elevation can help reduce pain and swelling for a more comfortable recovery.