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A fasciotomy is a procedure used to decompress acute compartment syndrome. Most commonly, acute compartment syndrome occurs in the leg and the forearm in the setting of acute trauma. This activity highlights the exact steps needed to perform 2 common fasciotomies. A high index of suspicion is necessary for the early detection of compartment syndrome, and a low threshold for intervention is needed by a trained healthcare professional. Objectives: Identify the indications for fasciotomy. Apply the technique of fasciotomy. Assess for the potential complications of fasciotomy. Create strategies with the interprofessional team for improving care coordination when performing fasciotomies to improve outcomes. Access free multiple choice questions on this topic.

A fasciotomy is an emergency procedure used to treat acute compartment syndrome. Compartment syndrome is when the pressure builds up in a non-compliant osseofascial compartment and causes ischemia leading to muscle and nerve necrosis. It occurs most commonly in the volar compartment of the forearm, deep posterior, or anterior leg compartment. It can, however, happen in any closed space where the muscle is surrounded by substantial fascia, eg, the hand, foot, thigh, or buttock. Compartment syndrome categorizes as acute or chronic. Acute compartment syndrome often follows high-energy trauma, fractures, circumferential burns, crush injuries, or a tight plaster cast. Chronic compartment syndrome develops with muscular overuse and commonly occurs in the leg of runners or military personnel or the forearm of weightlifters and rowers. Occasionally acute exertional compartment syndrome can be seen after strenuous exertion.

Due to muscle necrosis, rhabdomyolysis and acute renal failure are common; treatment is with intravenous fluids and dialysis.[9] Incomplete fasciotomies can create a need for a revision fasciotomy either to extend the fascial opening or open a missed compartment. Compartments are most commonly overlooked when the anatomy is highly distorted, such as in cases of high-energy trauma or patients with previous surgery and scarring. In these patients, the associated mortality increased by 4 times.[8] Also, patients who underwent a delayed fasciotomy have twice the amputation rate and 3 times the mortality. In some cases, even with timely fasciotomies, the affected limb may not regain normal functionality and may result in an amputation. Wound Complications are as follows: [10] [11] Need for skin grafting Scaring Tendon tethering Muscle herniation Recurrent ulceration Swollen limbs Discolored wounds Pruritus Dry, scaly skin Altered sensation

Early recognition of compartment syndrome is best detected by those professionals who have regular contact with the patients in the hospital. The hospital staff, typically attending physicians and nursing staff, has the most contact time with patients and is in the best position to detect increasing symptom severity. These staff members need the most training in recognizing compartment syndrome and need to exercise a high index of suspicion. The ability to escalate the situation in a timely fashion to a senior physician who can initiate early aggressive treatment with fasciotomy is crucial. Therefore, department management is responsible for ensuring all healthcare team members have adequate training in recognizing the symptoms, are familiar with pressure measuring equipment, and can escalate the situation appropriately and promptly. Implementing an interprofessional approach provides the best method for early detection to provide the best patient outcomes.