Fasciotomy

Anesthesia Implications

Position: Supine
Time: 30-60 min (short)
Blood Loss: Moderate (50 – 200 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: No

Approach – GETT. Subarachnoid or epidural block can be the approach if not contraindicated (eg. systemic infection or coagulopathy).

Post-Operative Ventilation – Consider post-operative ventilation for patients with ongoing hemodynamic instability.

Comorbidities – Patients with compartment syndrome often have no systemic disease whereas patients with necrotizing fasciitis might also have rhabdomyolysis and DIC.

Additional Lines – Patients with necrotizing fasciitis will need two IVs and an arterial line to guide inotropic/pressor therapy.

Renal Protection – To prevent renal damage, ensure adequate circulatory volume. Furosemide or mannitol may be needed.

Antibiotic – Typically cefazolin.

A fasciotomy is performed to decompress fascial compartments to either treat or prevent compartment syndrome. It is also the treatment for necrotizing fasciitis (this can also cause compartment syndrome). Increased intracompartmental pressure can occur after trauma (crush injury, fall, MVC) , prolonged vascular surgery (disruption of blood supply), or infection. Compartment syndrome is an emergency and must be treated within minutes to prevent loss of limb or death.

Compartment syndrome occurs when edema and/or blood builds up in a confined space and the delivery of oxygen to the tissues becomes compromised. Classic signs include the 5Ps: Pulselessness, pallor, pain, paralysis, and paresthesia.

If performing a leg fasciotomy, 1-4 compartments may be released, depending on where the injury occurred. These compartments are the anterior, lateral, deep posterior, and superficial posterior compartments.

If performing a fasciotomy of the leg, of all four compartments, two incisions will be made, one medial and one lateral. The fascia of each compartment will then be incised longitudinally. Typically the surgeon will not close the incisions because of the swelling.