Name of the Procedure:

Decompression Fasciotomy, Leg; Posterior Compartment(s) Only, with Debridement of Nonviable Muscle and/or Nerve

Summary

Decompression fasciotomy is a surgical procedure performed to relieve pressure within the muscles of the leg's posterior compartment. When muscle and/or nerve tissue has been damaged, debridement (removal of the non-viable tissue) is also necessary. This procedure is commonly used to treat conditions like compartment syndrome, which can cause severe pain and potential muscle and nerve damage.

Purpose

The purpose of this procedure is to treat compartment syndrome, a condition where increased pressure within the muscle compartments of the leg restricts blood flow and leads to tissue damage. The goals are to relieve the pressure, restore normal blood flow, and remove any dead or damaged muscle/nerve tissue to prevent further complications.

Indications

• Severe pain in the leg, especially when the pain is disproportional to the injury.
• Swelling, tightness, or firmness of the leg.
• Decreased sensation or numbness.
• Muscle weakness or paralysis in the leg.
• Compartment syndrome confirmed by clinical assessment or diagnostic tests.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Medication adjustments, especially blood thinners, may be necessary.
• Diagnostic tests such as MRI, CT scans, or compartment pressure measurements to confirm the diagnosis and assess the extent of tissue damage.

Procedure Description

1. Anesthesia: The patient is given regional or general anesthesia.
2. Incision: A surgical incision is made in the skin over the affected leg's posterior compartment.
3. Decompression: The fascia covering the muscle compartment is cut to relieve pressure.
4. Debridement: Any non-viable muscle and/or nerve tissue is carefully removed.
5. Closure: The surgical incisions are closed with sutures or left open if needed to ensure adequate decompression.

Tools and Equipment:

• Scalpel and surgical scissors
• Suction devices
• Retractors
• Surgical debridement tools

Duration

The procedure typically takes about 1 to 2 hours, depending on the extent of debridement required.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon or trauma surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Muscle weakness
• Chronic pain
• Scarring
• Compartment syndrome recurrence

Benefits

• Relief from severe pain due to compartment syndrome
• Prevention of permanent muscle and nerve damage
• Restoration of normal blood flow
• Potential for full recovery of leg function

Benefits can be realized almost immediately in terms of pain relief, though complete recovery may take several weeks.

Recovery

• Post-procedure monitoring in the recovery room.
• Pain management with prescribed medications.
• Instructions for wound care and signs of infection.
• Gradual return to physical activity as tolerated.
• Follow-up appointments to monitor healing and function.

Alternatives

• Conservative treatments such as physical therapy or medications may be tried initially, but these are often insufficient for acute compartment syndrome.
• Application of splints or casts in some cases.
• Hyperbaric oxygen therapy.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel any pain. Post-procedure, patients may experience discomfort and will receive pain management. There may be restrictions on activity, and physical therapy may be recommended to aid in recovery. Follow-up visits will help ensure proper healing and functionality of the leg.