Surgery for Compartment Syndrome

Acute compartment syndrome caused by a traumatic injury such as a fracture requires immediate treatment. If you experience severe muscle pain, numbness or tingling, a feeling of tightness in or around the muscle, or notice a pale or shiny skin tone around the affected area, NYU Langone doctors recommend that you go to the nearest emergency room immediately.

At the hospital, doctors perform surgery to relieve pressure in the affected muscle compartment to avoid further damage to muscles and nerves. Surgery is almost always successful as long as it is performed promptly. If treatment is not sought within 12 to 24 hours of the onset of symptoms, muscle and nerve tissue may become permanently damaged. Rarely, compartment syndrome may cause a complete loss of muscle function, and surgeons may need to amputate the limb. 

Surgery is performed for chronic compartment syndrome if symptoms have not been responsive to medical treatment.

Fasciotomy

Fascia are the thick sheets of connective tissue that surround muscle compartments. Fasciotomy, a procedure in which the fascia is cut to relieve pressure in the muscle compartment, is used to treat people with acute or chronic compartment syndrome. 

Before the procedure, doctors administer regional or general anesthesia. Your surgeon makes an incision above the affected muscle compartment, opening the restrictive fascia—thick sheets of connective tissue—to relieve pressure and increase blood flow to muscles and nerves. 

More than one incision may be required if multiple muscles are affected. In these instances, surgeons may also remove a section or sections of the fascia layer to permanently relieve pressure and lower the risk that compartment syndrome recurs. 

Surgeons close the incision as soon as the swelling goes down. For chronic compartment syndrome, this is on the same day, and you do not need to stay in the hospital overnight. 

For acute compartment syndrome, a more extensive incision may be required, and your surgeon may need to address other injuries such as a fracture or soft tissue damage before closing the incisions. Your doctor may recommend that you stay in the hospital for observation for one or more nights. 

If the swelling caused by acute compartment syndrome is severe, doctors may use a skin graft—a piece of healthy skin from another part of the body—to cover the area and help it heal. This technique may provide more space in the compartment, decreasing the risk of recurrence. In the weeks after surgery, the skin graft fuses to the surrounding skin.

What to Expect After Surgery

If the fasciotomy incision is closed on the same day as surgery, your doctor sees you five to seven days later. He or she examines the incision site to make sure it’s healing normally. 

During the first days after surgery, the injured leg or arm should be immobilized or elevated and no weight should be put on the affected limb. Your doctor can provide you with crutches or another type of assistive device to help you get around. 

After 10 to 14 days, your doctor removes the stitches or staples used to close the incision. After the incision heals, physical therapy begins to rebuild strength, flexibility, and range of motion.

If surgeons use a skin graft, you may need additional follow-up appointments so doctors can monitor the healing process. 

Pain management specialists at NYU Langone are available to help you manage any discomfort as you recover from surgery. 

The majority of people who have a fasciotomy avoid serious complications in the affected muscles and nerves and recover completely.

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