fasciotomy


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Fasciotomy

 

Definition

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

Purpose

The 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 the feet, being overweight, and 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 twelve months of conservative treatment (reducing time on feet, non-steroid anti-inflammatory drugs, arch supports) under the supervision of a doctor does not result in pain relief, a fasciotomy may be done. Fasciotomy removes a small portion of the fascia to relieve tension and pain. Connective tissue grows back into the cut space left by the cut, effectively lengthening the fascia.
When a fasciotomy is performed on other parts of the body, it is usually done to relieve pressure from a compression injury to a limb. This type of injury often occurs during contact sports. The 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 done to relieve this pressure and prevent tissue death. Similar injury occurs in high voltage electrical burns where deep tissue damage occurs.

Precautions

In the case of injury, fasciotomy is done on an emergency basis, and the outcome of the surgery depends largely on the general health of the patient. Plantar fasciotomies are appropriate for most people whose foot problems cannot be resolved in any other way.

Description

Fasciotomy in the limbs is usually done 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. It is done by a foot specialist in a doctor's office or outpatient surgical clinic under local anesthesia and takes 20 minutes to one hour. The doctor makes two small incisions on either side of the heel. An endoscope is inserted in one to guide the doctor in where to cut. A tiny knife is inserted in the other. A portion of the fascia is cut from near the heel; then the incisions are closed.

Preparation

Little preparation is done before a fasciotomy. When the fasciotomy is related to burn injuries, the fluid and electrolyte status of the patient 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.

Risks

In endoscopic plantar fasciotomy, the greatest risk 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.

Normal results

Fasciotomy in the limbs reduces pressure, thus reducing tissue death. Endoscopic plantar fasciotomy has a success rate of 90-95%.

Key terms

Endoscope — A tube that contains a tiny camera and light, that is inserted in the body to allow a doctor to see inside without making a large incision.

Resources

Other

"New Treatments for Heel Spur Syndrome." 〈http://www.footspecialist.com/heelspur.html〉.

fasciotomy

 [fas″e-ot´ah-me]
incision of a fascia.

fas·ci·ot·o·my

(fash'ē-ot'ŏ-mē),
Incision through a fascia; used in the treatment of certain disorders and injuries when marked swelling is present or anticipated, that could compromise blood flow; fasciotomy may be combined with embolectomy in the treatment of acute arterial embolism.
[fascio- + G. tomē, incision]

fasciotomy

/fas·ci·ot·o·my/ (fas″e-ot´ah-me) incision of a fascia.

fasciotomy

(făsh′ē-ŏt′ə-mē)
n.
Surgical incision through a fascia.

fasciotomy

[fas′ē·ot′əmē]
a surgical incision into an area of fascia.
enlarge picture
Fasciotomy

fasciotomy

Orthopedics The incision through a fascial plane, usually to relieve neurovasular pressure in an underlying muscle compartment

fas·ci·ot·o·my

(fash'ē-ot'ŏ-mē)
Incision through a fascia; used in the treatment of some vascular disorders and injuries when marked swelling is anticipated, which could compromise blood flow; fasciotomy may be combined with embolectomy in the treatment of acute arterial embolism.
[fascio- + G. tomē, incision]

fasciotomy

Cutting fascia, usually to relieve damaging tension in a muscle compartment or prevent compression of arteries or nerves. Fasciotomy may become necessary if the development of muscles, as in an athlete, exceeds the space available to them in their fascial compartments.

fasciotomy

incision to divide fascia

fasciotomy

incision of a fascia.
References in periodicals archive ?
Fasciotomy was noted if surgery had been performed for necrotizing fasciitis.
The patient was urgently transferred to theatre where the right femoral artery was repaired, a right thigh fasciotomy performed, and the right-sided scrotal wound debrided.
In some cases, surgical intervention (including fasciotomy, skin graft, and/or amputation) may be required (see ADVERSE REACTIONS).
The company said the long-term Xiaflex results compare with a 39% recurrence rate for patients undergoing a surgical procedure called fascietomy and a recurrence rate of 85% with another surgical procedure, called needle fasciotomy.
A diagnosis of acute compartment syndrome was made and the patient was immediately taken to the operating theatre for a forearm fasciotomy.
Snakebite treatment may eventually include fasciotomy or amputation for deteriorating compartment syndrome.
That condition had developed to the point that the patient required a fasciotomy, an incision along the length of the compartment where the blood had collected, to relieve the pressure in her arm.
Objective: We aimed to compare the postoperative complications in patient with acute lower extremity arterial occlusion who admitted in the late period in whom accompanying embolectomy and fasciotomy in the same session and fasciotomy following embolectomy were applied, because of development of compartment syndrome.
Tobin performed a fasciotomy, making five incisions in his left leg - the largest opening the size of a football on his quadriceps - plus two more on his right arm, including a cut that started in the middle of his palm and ran almost 12 inches toward the bend in his arm.
The second is a fast and effective procedure called needle fasciotomy, which takes 20 minutes, costs about $1,500, and has shown excellent results in many patients.
Early fasciotomy and debridement in NF have been associated with improved survival compared with delayed surgical exploration.