fasciotomy

Fasciotomy is a surgical procedure in which the fascia surrounding muscle compartments is incised to relieve elevated intracompartmental pressure and restore perfusion to the muscles and nerves within the compartment.

The most common indication is acute compartment syndrome, typically after traumatic injury such as fractures, crush injuries, severe contusions, or reperfusion after vascular injury. It may also be performed prophylactically in high-risk cases (for example, after extensive burns, severe swelling, or during vascular repair) to prevent pressure buildup. Limb compartments are bounded by relatively inelastic fascia; swelling or bleeding within a compartment increases pressure, compromising blood flow and threatening muscle and nerve function if not relieved. The leg has four to six compartments, the forearm two to three, and other limbs have their own compartment patterns.

The procedure is usually performed emergently when acute compartment syndrome is diagnosed or highly suspected. The surgeon makes incisions to release the involved compartments’ fascia, allowing muscle edema to expand without further compressive pressure. The skin may be left open or closed loosely to accommodate ongoing swelling, and wound management may involve temporary dressings, vacuum-assisted closure, or delayed primary closure with skin grafting if needed. In the leg, common approaches release all affected compartments; in the forearm, one or more compartments are released as indicated.

Diagnosis relies on clinical signs such as severe persistent pain disproportionate to exam findings, worsening pain with passive stretch, paresthesias, and later pallor or pulselessness. Intracompartment pressure measurement can aid decision-making when the diagnosis is uncertain; thresholds vary, but a delta pressure (diastolic minus pressure) of less than about 20 to 30 mmHg or absolute pressures above about 30 mmHg suggest fasciotomy. Early intervention improves outcomes, while delays can lead to muscle necrosis, nerve injury, and functional impairment.