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Definition

Fasciotomy is a surgical procedure that cuts away the fascia to relieve tension or pressure.

Purpose
Fascia is thin connective tissue covering, or separating, the muscles and internal organs of the
body. It varies in thickness, density, elasticity, and composition, and is different from ligaments
and tendons.
The fascia can be injured either through constant strain or through trauma. Fasciitis is an
inflammation of the fascia. The most common condition for which fasciotomy is performed is
plantar fasciitis, an inflammation of the fascia on the bottom of the foot that is sometimes called
a heel spur or stone bruise.
Plantar fasciitis is caused by long periods on one's feet, being overweight, or wearing shoes that
do not support the foot well. Teachers, mail carriers, runners, and others who make heavy use of
their feet are especially likely to suffer from plantar fasciitis.
Plantar fasciitis results in moderate to disabling heel pain. If nine to 12 months of conservative
treatment (reducing time on feet, nonsteroid anti-inflammatory drugs, arch supports) under the
supervision of a doctor does not result in pain relief, a fasciotomy may be performed.
Fasciotomy removes a small portion of the fascia to relieve tension and pain. Connective tissue
grows back into the space left by the incision, effectively lengthening the fascia.
When a fasciotomy is performed on other parts of the body, the usual goal is to relieve pressure
from a compression injury to a limb. This type of injury often occurs during contact sports or
after a snake bite. Blood vessels of the limb are damaged. They swell and leak, causing
inflammation. Fluid builds up in the area contained by the fascia. A fasciotomy is performed to
relieve this pressure and prevent tissue death. Similar injury occurs in high-voltage electrical
burns that cause deep tissue damage.

Demographics
People who are likely to need a fascictomy include the following:

athletes who have sustained one or more serious impact injuries

people who spend long periods of time on their feet

people with severe burns

persons who are overweight

snakebite victims

There is a slight male predominance among people undergoing a fasciotomy.

Description
Fasciotomy in the limbs is usually performed by a surgeon under general or regional anesthesia.
An incision is made in the skin, and a small area of fascia is removed where it will best relieve
pressure. Then the incision is closed.
Plantar fasciotomy is an endoscopic (performed with the use of an endoscope) procedure. The
doctor makes two small incisions on either side of the heel. An endoscope is inserted in one
incision to guide the doctor. A tiny knife is inserted in the other. A portion of the fascia near the
heel is removed. The incisions are then closed.

Diagnosis/Preparation
In the case of injury, fasciotomy is performed on an emergency basis, and the outcome of the
surgery depends largely on the general health of the injured person. Plantar fasciotomies are
appropriate for most people whose foot problems cannot be resolved in any other way.
Little preparation is needed before a fasciotomy. When the fasciotomy is related to burn injuries,
the fluid and electrolyte status of the affected person are constantly monitored.

Aftercare
Aftercare depends on the reason for the fasciotomy. People who have endoscopic plantar
fasciotomy can walk without pain almost immediately, return to wearing their regular shoes
within three to five days, and return to normal activities within three weeks. Most will need to
wear arch supports in their shoes.

Persons who require fasciotomy as a result of an injury or snake bite are usually able to resume
their normal activities in a few weeks.

Risks
The greatest risk with endoscopic plantar fasciotomy is that the arch will drop slightly as a result
of this surgery, causing other foot problems. Risks involved with other types of fasciotomy are
those associated with the administration of anesthesia and the development of blood clots or
postsurgical infections.

Normal results
Fasciotomy in the limbs reduces pressure, thus reducing tissue death. Endoscopic plantar
fasciotomy has a success rate in excess of 95%.

Morbidity and mortality rates


The most common morbidity in a fasciotomy is an incomplete response that requires a repeat
fasciotomy procedure. Mortality is very rare and usually due to a problem related to the original
condition.

Alternatives
Conservative nonoperative treatment for plantar fasciitis consists of nonsteroidal antiinflammatory drugs for several weeks. For persons who spend excessive time on their feet, a
change of occupation or the use of arch supports may be useful. Overweight individuals may
consider weight reduction to reduce the stress placed on their feet. For persons bitten by a
poisonous snake, there are no acceptable alternatives to a fasciotomy, and there are rarely
acceptable alternatives to fasciotomy for a person who has been burned.
http://www.surgeryencyclopedia.com/Ce-Fi/Fasciotomy.html
Surgery (fasciotomy)
The treatment for acute compartment syndrome is surgery (fasciotomy). The surgeon (either an
orthopedic or general surgeon) will perform a fasciotomy, an operation where the thick, fibrous
bands that line the muscles are filleted open, allowing the muscles to swell and relieve the

pressure within the compartment (similar to splitting open the casing of a sausage). Depending
upon the amount of swelling (edema), a second operation may be required later to close the skin
after the swelling has resolved.
Once acute compartment syndrome has occurred, there is no non-surgical alternative. Hyperbaric
oxygen may be considered as an adjunct treatment after surgery to promote healing.
Treatment will also be directed to the underlying cause of the compartment syndrome and to try
to prevent other associated complications including kidney failure due to rhabdomyolysis.
http://www.medicinenet.com/compartment_syndrome/article.htm

Fasciotomy

Definition
Fasciotomy is a surgical procedure to reduce pressure around muscles, nerves, tendons, or blood
vessels. These structures are encased by a thin connective tissue capsule (compartment) that may
not be able to expand enough to accommodate swelling inside the compartment (compartment
syndrome, or CS). The connective tissue capsule is called a fascia, and fasciotomy is a surgical
procedure that cuts the fascia open, usually to relieve pressure. Swelling and increased pressure
may result from fractures, damage to blood vessels (vascular injury), crush injuries, or other
trauma. When pressure builds within a compartment, the blood supply to the local nerves and
muscle is disrupted. If the pressure is not relieved, tissue and nerve damage can result.
Individuals who have suffered injuries with extensive soft tissue destruction and fracture
involving the lower arm or leg are at greater risk for acute compartment syndrome requiring a
fasciotomy because muscle compartments in these locations are smaller and more confining.
Fingers may be involved as a result of crushing injuries or snakebites.
CS is usually acute, but in some athletes (long-distance runners) chronic compartment syndrome
may develop.
Source: Medical Disability Advisor

Reason for Procedure


Fasciotomy is used to relieve pressure and lessen the likelihood of tissue injury and death. In
acute injuries or postfracture care, failure to relieve this pressure may result in neurovascular
compromise and, ultimately, in loss of function of the affected limb or extremity. Left untreated,
severe compartment syndrome may lead to amputation.

When the pressure in a compartment rises acutely, the situation may be limb-threatening and
should be treated as an emergency. In more chronic situations, the pressure in the compartment
may rise and fall with activity. If a change in activity or conditioning does not relieve the pain,
elective surgery may be performed. In either situation, the surgeon will open the fascia to allow
the muscle to expand, increasing circulation and decreasing pressure.
In more chronic conditions in the lower leg caused by overuse, fasciotomy is performed when
conservative treatment measures have failed to relieve pain or improve function. Fasciotomy
may also be performed for severe cases of heel pain due to plantar fasciitis and in Dupuytrens
contracture, a thickening of the palmar fascia that can lead to contraction of the fingers.
Source: Medical Disability Advisor

How Procedure is Performed


Fasciotomy involves making incisions through the skin over the affected compartment, most
commonly in the lower leg or forearm. The incision and dissection are carried down to the fascia
surrounding the muscles. Careful attention must be paid to the nerves and blood vessels in the
area. Sometimes multiple small incisions are made in the skin and fascia; in other situations,
long continuous incisions are made over the entire compartment.
In acute cases, the incisions may be left open and covered with wet sterile dressings, which
allow the muscle to swell up and out of the skin. Once the pressure in the compartment is
relieved, circulation is restored and swelling decreases; this leads to a decrease in pain and,
ultimately, restoration of muscle function. The individual may need additional surgery or
surgeries for secondary wound closure and/or skin grafting.
When treating more chronic compartment syndrome, the surgeon leaves the fascia open and
closes the overlying layers of tissue and skin with sutures.
Fasciotomy requires general or regional anesthesia and, except in extreme emergencies, is
performed in the operating room. Compartment pressure readings are monitored during and after
the procedure. Surgeons have performed a fasciotomy on the sole of the foot (plantar
fasciotomy) using an endoscope (endoscopic plantar fasciotomy; Barrett procedure) and
experienced mixed, but some highly favorable results (Saxena; Murphy).
Source: Medical Disability Advisor

Prognosis
In cases of acute compartment syndrome, treatment with fasciotomy within 12 hours of onset of

symptoms results in retention of normal limb function in 68% of cases. Delay of fasciotomy for
more than 12 hours after onset of acute symptoms reduces retention of normal function to 8%
(Wallace, Compartment Syndrome: Upper Extremity). Delayed correction of CS for as little as
2 to 4 days may result in permanent damage. Left untreated, CS may result in tissue death
(necrosis) and limb amputation. Return to normal function after a successful fasciotomy usually
takes 2 to 3 months. Despite early and aggressive fasciotomy, nearly 20% of individuals may
retain some motor or sensory deficit at a 1-year follow-up exam (Wallace, Compartment
Syndrome: Lower Extremity).
Source: Medical Disability Advisor

Rehabilitation
Note on research and authorship
Fasciotomy is a surgical treatment for acute or chronic compartment syndromes (Brennan;
Tiwari). The rehabilitation treatment depends on the cause of the compartment syndrome, as
well as on the integrity and condition of the soft tissue and wound following surgery (Blaisdell;
Seiler).
If indicated, the therapist begins with gentle active range of motion of the adjacent joints. During
the early phase of therapy, exercises must be taught and progressed very gradually so as not to
compromise the blood supply or healing of the involved soft tissue.
Once the soft tissue is healed and the wound is closed, range of motion exercises are continued,
and gentle strengthening exercises can be initiated, based on the physician's protocol. If these
exercises are well tolerated, the therapist includes strengthening exercises of greater difficulty
until full strength of the involved body part is restored. When indicated, coordination and
endurance exercise can be added.
The therapist must be mindful of the underlying etiology, remaining observant for a recurrence
of the preoperative symptoms and instructing the individual to do the same. If such symptoms
are noted, all exercise must be discontinued and reported to the physician immediately. Before
discharge from therapy, the individual should receive instruction in a home exercise program to
complement supervised rehabilitation and to be continued independently until full function
returns.
FREQUENCY OF REHABILITATION VISITS
Surgical
Specialist
Fasciotomy
Physical, Occupational or
Up to 12 visits within 6
Hand Therapist
weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated

cases. It provides a framework based on the duration of tissue healing time and standard
clinical practice.
Source: Medical Disability Advisor

Complications
Possible complications of the procedure include skin sloughing; infection; nerve, blood vessel,
and muscle damage; and scarring. Contractures of the skin and soft tissue may result from either
the initial procedure or secondary wound closure. If skin grafting is required, there could be
infection, scarring, and contracture at the donor site. Muscle weakness may also occur.
Compartment syndrome may recur in as many as 3% to 20% of cases after fasciotomy (Barr).
Causes include excessive formation of scar tissue and inadequate initial release of the fascia.
Source: Medical Disability Advisor

Return to Work (Restrictions / Accommodations)


Individuals who have undergone lower extremity fasciotomy and have jobs that require long
periods of standing or walking may need to be reassigned to more sedentary duties. Individuals
who have undergone upper extremity fasciotomy may need to avoid repetitive gripping, twisting,
lifting, and carrying duties that require extensive use of the arm or wrist. These individuals may
need to be temporarily or permanently assigned to other duties. Postoperative reconditioning of
the affected muscle groups is important.
Source: Medical Disability Advisor

Factors Influencing Duration


Factors include site of treatment, duration and extent of condition, development of necrosis or
other complications, individual compliance, the individual's job requirements and ability to
modify activities as necessary, and the particular type of physical activity the individual pursues.
If the fasciotomy was done after an acute injury, length of disability depends on recovery from
the underlying injury as well as the fasciotomy. Job requirements and inability to adapt to
activity changes may prolong disability.
For the forearm, duration for sedentary and light work may be shorter if one-handed work is
available (modified duty). For the leg, duration for sedentary and light work may be shorter if
work can be performed in a sitting position.
http://www.mdguidelines.com/fasciotomy

Fasciotomy
By L. Fleming Fallon Jr., MD, DrPHThe Gale Group Inc., Galemore

Description

Fasciotomy in the limbs is usually performed by a surgeon under general or regional anesthesia.
An incision is made in the skin, and a small area of fascia is removed where it will best relieve
pressure. Then the incision is closed.
Plantar fasciotomy is an endoscopic (performed with the use of an endoscope) procedure. The
doctor makes two small incisions on either side of the heel. An endoscope is inserted in one
incision to guide the doctor. A tiny knife is inserted in the other. A portion of the fascia near the
heel is removed. The incisions are then closed.

Diagnosis/Preparation

In the case of injury, fasciotomy is performed on an emergency basis, and the outcome of the
surgery depends largely on the general health of the injured person. Plantar fasciotomies are
appropriate for most people whose foot problems cannot be resolved in any other way.
Little preparation is needed before a fasciotomy. When the fasciotomy is related to burn injuries,
the fluid and electrolyte status of the affected person are constantly monitored.

Aftercare

Aftercare depends on the reason for the fasciotomy. People who have endoscopic plantar
fasciotomy can walk without pain almost immediately, return to wearing their regular shoes
within three to five days, and return to normal activities within three weeks. Most will need to
wear arch supports in their shoes.
Persons who require fasciotomy as a result of an injury or snake bite are usually able to resume
their normal activities in a few weeks.

Risks

The greatest risk with endoscopic plantar fasciotomy is that the arch will drop slightly as a result
of this surgery, causing other foot problems. Risks involved with other types of fasciotomy are
those associated with the administration of anesthesia and the development of blood clots or
postsurgical infections.

Normal results

Fasciotomy in the limbs reduces pressure, thus reducing tissue death. Endoscopic plantar
fasciotomy has a success rate in excess of 95%.
Morbidity and mortality rates

The most common morbidity in a fasciotomy is an incomplete response that requires a repeat
fasciotomy procedure. Mortality is very rare and usually due to a problem related to the original
condition.

Read more: http://www.healthline.com/galecontent/fasciotomy-1/2#ixzz1LMeFMrQ1


Healthline.com - Connect to Better Health

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