Fasciotomy

Fasciotomy is a surgical procedure that cuts away the fascia to relieve tension or pressure

Purpose

The fascia is thin connective tissue covering, or separating, the muscles and internal organs of the body. It varies in thickness, density, elasticity, and composition, and is different from ligaments and tendons.

The fascia can be injured either through constant strain or through trauma. Fasciitis is an inflammation of the fascia. The most common condition for which fasciotomy is performed is plantar fasciitis, an inflammation of the fascia on the bottom of the foot that is sometimes called a heel spur or stone bruise.

Plantar fasciitis is caused by long periods on the feet, being overweight, and wearing shoes that do not support the foot well. Teachers, mail carriers, runners, and others who make heavy use of their feet are especially likely to suffer from plantar fasciitis.

Plantar fasciitis results in moderate to disabling heel pain. If nine to twelve months of conservative treatment (reducing time on feet, non-steroid anti-inflammatory drugs, arch supports) under the supervision of a doctor does not result in pain relief, a fasciotomy may be done. Fasciotomy removes a small portion of the fascia to relieve tension and pain. Connective tissue grows back into the cut space left by the cut, effectively lengthening the fascia.

When a fasciotomy is performed on other parts of the body, it is usually done to relieve pressure from a compression injury to a limb. This type of injury often occurs during contact sports. The blood vessels of the limb are damaged. They swell and leak, causing inflammation. Fluid builds up in the area contained by the fascia. A fasciotomy is done to relieve this pressure and prevent tissue death. Similar injury occurs in high voltage electrical burns where deep tissue damage occurs.

Precautions

In the case of injury, fasciotomy is done on an emergency basis, and the outcome of the surgery depends largely on the general health of the patient. Plantar fasciotomies are appropriate for most people whose foot problems cannot be resolved in any other way.

Description

Fasciotomy in the limbs is usually done by a surgeon under general or regional anesthesia. An incision is made in the skin, and a small area of fascia is removed where it will best relieve pressure. Then the incision is closed.

Plantar fasciotomy is an endoscopic (performed with the use of an endoscope) procedure. It is done by a foot specialist in a doctor's office or outpatient surgical clinic under local anesthesia and takes 20 minutes to one hour. The doctor makes two small incisions on either side of the heel. An endoscope is inserted in one to guide the doctor in where to cut. A tiny knife is inserted in the other. A portion of the fascia is cut from near the heel; then the incisions are closed.

Preparation

Little preparation is done before a fasciotomy. When the fasciotomy is related to burn injuries, the fluid and electrolyte status of the patient are constantly monitored.

Aftercare

Aftercare depends on the reason for the fasciotomy. People who have endoscopic plantar fasciotomy can walk without pain almost immediately, return to wearing their regular shoes within three to five days, and return to normal activities within three weeks. Most will need to wear arch supports in their shoes.

Risks

In endoscopic plantar fasciotomy, the greatest risk is that the arch will drop slightly as a result of this surgery, causing other foot problems. Risks involved with other types of fasciotomy are those associated with the administration of anesthesia and the development of blood clots.

Normal results

Fasciotomy in the limbs reduces pressure, thus reducing tissue death. Endoscopic plantar fasciotomy has a success rate of 90–95%.