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When the blood supply to the tissues is suddenly interrupted, a series of reactions occur that eventually lead to microcirculatory failure. As a result, the very small blood vessels lose their ability to regulate the flow of fluid across their walls. If the blood flow is restored, large volume of fluid diffuses through the damaged vessels into the tissues and particularly muscles. This abnormal build up of tissue fluids soon exerts enough pressure to stop the blood flow again, and leading to what is called "compartment syndrome". Fasciotomy surgery is designed to prevent compartment syndrome by making release incisions through the dense fibrous tissue surrounding the muscles. This allows the excess tissue fluid to drain, thus preserving the microcirculatory blood flow.
Fasciotomy is most commonly performed on the calf. Less commonly, they may be performed on the thigh or arm. Fasciotomies are performed either independently or as part of emergency surgery for arterial occlusion or trauma. The anaesthetic required varies and ranges between local, regional or general. Leg fasciotomy involves a long incision on either side of the leg. The incisions extend nearly from the knee to the ankle. These incisions are covered with dressings for several days before they are closed. Invariably, skin grafting may be required to assist closure of these wounds.
The commonest complications are wound related. These include infection, skin necrosis and retraction. The majority of patients will require skin grafting to achieve complete coverage of the wound. |
Muscle swelling following arterial injury. Without this long release incision (fasciotomy), the muscles will rapidly die.
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