Fasciotomy - surgery for compartment syndrome

The muscles in your arms and legs, together with nearby blood vessels and nerves, are in bundles surrounded by tissue called fascia. These bundles are called compartments. 

Compartment syndrome is an increase in pressure caused by bleeding or swelling within the compartment. If it is not treated, it can restrict blood flow to the muscles and nerves. This can lead to loss of sensation in the skin, and loss of movement of the affected arm or leg (limb). 

This is most common in the calf or thigh, but can happen in any compartment. 

Causes of compartment syndrome

If you have had surgery to repair a damaged or blocked blood vessel, the sudden increase in blood flow to the muscles can lead to increased pressure. An injury, such as a fracture, can also cause swelling of the muscle and tissues in the compartment. 

Increased pressure in the compartment can restrict blood flow. This means that oxygen is not delivered to the muscles, and the muscles can become damaged. Damaged muscles make and release chemicals, which can make the swelling and pressure worse. 

Symptoms of compartment syndrome

The main symptom of compartment syndrome is severe pain. You are likely to have some pain after surgery or an injury. However, in compartment syndrome the pain is worse than the pain you should expect. You might have less strength and movement in the limb. The limb might also be pale, cold, and feel tense and hard.

Nerve damage can cause a burning sensation, and pins and needles in the affected limb. You might have numbness when the skin is touched. 

Risks of compartment syndrome

If compartment syndrome is not treated, it can lead to: 

  • permanent nerve damage
  • permanent muscle damage, and difficulty moving around (reduced mobility)
  • an infection
  • kidney failure, as when muscles die they release chemicals that can damage the kidneys
  • amputation of the affected limb if there is a lot of muscle damage

Surgery to treat compartment syndrome

Compartment syndrome should be treated as quickly as possible to lower the risk of long-term nerve and muscle damage. Treatment aims to lower the pressure in the compartment by having surgery called a fasciotomy.

In a fasciotomy, the skin and compartment are cut open to relieve the pressure. If any muscles in the compartment have died, the surgeon will remove them during surgery. 

The wound is usually left open after surgery, to stop the pressure from building up again. It might be closed using stitches some days later, or it can be left to heal by itself. 

Your surgeon might decide to help the wound to heal by doing a skin graft, but this is not suitable for everyone. A skin graft is a layer of skin taken from somewhere else on your body, usually your leg, to place over the wound. Your surgeon will explain this to you in more detail. 

Some people have a fasciotomy to stop compartment syndrome happening if they are at a high risk of developing it. 

Risks of having a fasciotomy

As with any major operation, there are risks to having surgery under a general anaesthetic. 

Your surgical team will talk to you about all possible risks, and how they might affect you. You will be able to ask any questions you have.  

You can read more about having a general anaesthetic.

We want to involve you in decisions about your care and treatment. If you decide to have a fasciotomy, you will be asked to sign a consent form. This says that you understand what is involved and agree to have the treatment. 

You can read more about our consent process.

Outlook for compartment syndrome

The outlook (prognosis) of compartment syndrome depends on how quickly it is diagnosed and treated. It also depends on if the nerves or muscles have been damaged by the lack of blood flow to the area. 

Recovery of the nerves and muscles is possible if compartment syndrome is treated quickly. However, they can often take weeks, or even months, to fully recover. 

After surgery

Wound care

In some cases, the wound is left to heal on its own. Or, a special vacuum dressing called a topical negative pressure dressing, or a vacuum assisted closure (VAC), might be used. You might be sent home from hospital (discharged) with this type of dressing. If you are, we will arrange for your GP’s practice nurse, or a district nurse, to change this dressing when you are at home. It can take about 4 to 6 weeks for the wound to heal, sometimes longer. 

Things that can help you recover

After surgery, there are things you can do to help your recovery. 

  • Tell your doctor or nurse if you have any pain that gets worse.
  • Tell your doctor or nurse if you have a high temperature (fever). 
  • The physiotherapist will give you exercises for your affected limb, make sure you do these exercises and follow their instructions. 
  • Drink plenty of fluids.
  • Eat a healthy, balanced diet to help your wound heal.
  • If you smoke, the most important thing you can do to help yourself is stop smoking. For help, speak to a nurse, call the Trust Stop Smoking Service, phone: 020 7188 0995, or call the NHS Smoking Helpline, phone: 0300 123 1044

Resource number 3669/VER5
Published date: February 2024
Review date: February 2027

Contact us

If you have any questions or concerns before or after you have left hospital, please refer to your after visit summary for contact details, Monday to Friday, 8am to 4pm.

Out of hours, please leave a message and a member of staff will call you back in working hours.

Alternatively, please contact your GP or NHS 111.

You can also contact your ward 24 hours a day, to speak to the ward sister, or nurse in charge.

Do you have any comments or concerns about your care?

Contact our Patient Advice and Liaison Service (PALS)

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