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Fasciotomy Indications: Compartment Syndrome, Burns, and Vascular Injury

Fasciotomy (surgical fascial release) is the definitive treatment for compartment syndrome—elevated pressure within a closed fascial space compromising perfusion.

Indications

Diagnosis

Clinical: Pain out of proportion, paresthesia, pallor, pulselessness (late), paralysis (late), pressure (tense compartment).
Intracompartmental pressure (ICP) monitoring: ΔP (diastolic BP − ICP) <30 mmHg → fasciotomy.
Near-infrared spectroscopy (NIRS), ultrasound (emerging).

Surgical Technique

Leg (4-compartment): Dual incision (anterolateral + posteromedial) or single lateral (controversial).
Forearm (volar ± dorsal): Volar (carpal tunnel release often added); dorsal for dorsal compartment.
Hand: Dorsal interosseous + thenar/hypothenar.
Foot: Medial + lateral plantar + dorsal.

Skin left open → delayed primary closure or skin graft (7–14 days).

Complications

Infection, nerve injury, vascular injury, hernia, chronic pain, cosmetic deformity.
Rhabdomyolysis → AKI (monitor CK, urine output).

Fasciotomy is limb- and life-saving; delay causes irreversible neuromuscular damage.

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Cause	Mechanism	Urgency
Acute compartment syndrome	Fracture (tibia, forearm), crush, reperfusion, tight cast, anticoagulation	Emergent (<6h for irreversible damage)
Chronic exertional compartment syndrome (CECS)	Exercise-induced ↑ pressure (fascial non-compliance)	Elective (after failed conservative)
Severe burns	Circumferential deep dermal/full thickness → eschar constriction	Emergent (escharotomy) → fasciotomy if deep
Vascular injury/reperfusion	Ischemia-reperfusion edema post-revascularization	Prophylactic at time of vascular repair
Infection	Necrotizing fasciitis, gas gangrene	Emergent (debridement + fasciotomy)
Snake envenomation	Massive edema, myonecrosis	If pressures elevated despite antivenom
IV extravasation	Vesicant/irritant infiltration	If compartment pressures rise