A fasciotomy procedure involves making incisions through the fascia to relieve pressure or tension. The surgical procedure is commonly indicated for compartment syndrome, which results from pressure within a closed fascial space, leading to reduced circulation of blood to the muscles and nerves within that space. Mainly, fasciotomy is aimed at relieving the pressure in the indicated compartment and restoring the associated blood flow. Fasciotomy is basically a limb-saving procedure that is utilized to treat patients with acute compartment syndrome. Overall, the method is used to handle the 6Ps of compartment syndrome (pain, paresthesia, paralysis, pulselessness, and pallor) (Sraj et al., 2022). Because of the need to accurately and effectively handle care, it is necessary to analyze fasciotomies through the procedure, risks and benefits, the roles of the interdisciplinary team, nursing considerations, and patient education.
Explanation and Background
Overall, the procedure costs around $ 3,586, but individuals with high deductible plans may compare prices and probably save (Aliu et al., 2021). Fasciotomies involve making incisions through the fascia and skin overlying a subject muscle compartment like the posterior or anterior compartments of the lower leg. The procedure leads to the relief of pressure on the muscles by decompressing the compartment muscles and nerves. Sraj et al. (2022) indicate that fasciotomies are mostly targeted for patients with trauma, ischemia, burns, or surgeries. Pressure accumulation in the closed fascial compartment compromises and inhibits blood flow. Eventually, the blood flow compromise leads to nerve damage, tissue ischemia, and, in untreated cases, muscular necrosis. A fasciotomy must be performed as soon as the diagnosis of acute compartment syndrome has been identified to avert irreversible damage.
The procedure is executed at the bedside under local anesthesia. First, a longitudinal incision is carefully made over the fascial compartment with regard to underlying nerves and blood vessels (Torlincasi, 2023). Next, the incision is made to decompress another aspect of the same compartment where necessary. The surgical team will then inspect the muscle tissue for necrosis, and if present, any necrotic tissue will be debrided. Finally, the wound is left open and covered with moist, sterile dressings.
Despite the relieving elements of fasciotomies, it is necessary to note that these procedures carry several demerits. Etemad-Rezaie et al. (2022) indicate that fasciotomies are conspicuous with possible infections, nerve and vessel damage, and bleeding. Despite these limitations, Torlincasi (2023) asserts that the risks associated with untreated compartment syndrome are more severe, including the risk for Volkmann ischemic contracture, which can lead to permanent paralysis and muscle. Patients must access close symptom monitoring after the procedure to handle signs of complications or continued compartment syndrome.
Risks and Benefits
Among the benefits of fasciotomies is the evidenced relieving of pressure and aversion of irreversible nerve and muscle damage to fascial compartments. Various considerations must, however, be accounted for to assess the optimal outcomes and benefits of the procedure (Sraj et al., 2022). Timely completion of the procedure leads to the preservation of nerve and muscle function. Indications relate to immediate pain relief reports from patients as soon as the compartment pressure is relieved.
As mentioned above, fasciotomy is not without risks. Aliu et al. (2021) evidence that incisions through the fascia increase risks for infection and, most importantly, instigate impaired wound healing. This might lead to some patients developing complex regional pain syndrome. Additionally, the procedure carries further risks of unfavorable scarring, nerve and blood vessel damage, and bleeding. Some patients have reported experiencing functional deficits and strength losses after compartment release. Overall, the incisions lead to wounds that demand extensive nursing care to initiate healing and prevent associated patient complications.
Various executions must be implemented to promise high accuracy and efficiency of the procedure. First, the effective execution of the aseptic procedure during the surgery can help decrease the likelihood of infections (Torlincasi, 2023). Also, antibiotics may be prescribed alongside positioning the patient’s leg correctly to avoid nerve damage. It is paramount to prevent muscular necrosis as the primary attribute in enabling optimal functional recovery. In all instances, healthcare practitioners must act promptly to ensure that suspected compartment syndrome does not compromise the chances of salving nerve and muscle function.
Interdisciplinary Team’s Roles and Responsibilities
Caring for fasciotomy patients requires effective collaboration and teamwork capabilities across interdisciplinary teams. Providers such as surgeons, nurses, physical therapists, case managers, and occupational therapists are central to the effective handling of the case. Surgeons, for instance, are responsible for the procedure and must monitor for adequate decompression and muscle necrosis and, where necessary, debride the damaged tissue (Aliu et al., 2021). Also, the surgeons collaborate with the team to manage the after-procedure wound care. Physical therapists aid in guiding functional recovery, strength exercises, and range of motion exercises. On the other hand, occupational therapists assist with ADLs by offering adaptive equipment as recommended. Finally, the case manager facilitates the discharge plans and follow-up care as recommended.
Nurses have an integral role in the execution of the procedure and the post-procedure patient care. During the procedure, nurses must monitor compartment pressures and clinical signs of compartment syndrome. Also, they are tasked with patient education, wound care, and postoperative monitoring. Etemad-Rezaie et al. (2022) establish that nurses are responsible for the early detection of compartment syndrome and advocating for prompt patient treatment. One of the most significant challenges that nurses face during this procedure is creating compelling and clear communication that collaboratively pulls all stakeholders together.
Nursing Scope of Practice
The proper care for fasciotomy patients requires specialized knowledge, skills, and professional attitudes. All nurses must understand the anatomy, pathophysiology, and rationale of the compartment syndrome. Also, the nurses must accurately assess compartment pressures and monitor for clinical signs like pain, pallor, paralysis, and paresthesias (Sraj et al., 2022). To properly execute the responsibilities, the individuals must possess and execute skills in wound care, sterile technique, and patient education. Notably, the nurses must portray compassion while providing patient care and guidance on potential functional deficits. Overall, the role of a nurse integrates executions related to the prevention, detection, and treatment attributes of compartment syndrome.
Patient Education
Patient education for fasciotomy should be expedited preoperatively and postoperatively. The former integrates deliberate and well-established engagements to expose the patient to the risks and benefits of fasciotomy based on the severity of compartment syndrome (Aliu et al., 2021). In this situation, the patients must understand the need for urgency and the implications of delays. Furthermore, the education must encompass details on how the procedure will be executed.
On the other hand, postoperative care includes focused attention on infection prevention, wound dressing protocols, prescribed exercises, and pain management. Nurses should collaborate with the patient to create realistic care expectations related to muscle function. The patients must be taught proper skin care, nutrition, and how to identify infections (Torlincasi et al., 2023). Overall, all education must be patient-tailored, and nurses must individually assess established patient understanding.
Conclusion
In conclusion, fasciotomy is an integral procedure in averting the progression of acute compartment syndrome and, consequently, preventing permanent neuromuscular damage. As highlighted, it is necessary to account for the benefits and associated benefits per patient level. It would also be necessary to ensure that rapid diagnosis is followed by prompt decision-making in treatment among all the associated stakeholders. The collaborative insight from a multidisciplinary team would allow for thorough safety and procedural accuracy in completing the procedure. Importantly, it is necessary to identify that nurses have a critical role in meeting the pre and post-elements of fasciotomy and limb-saving procedures.
References
Aliu, O., Lee, A. W., Efron, J. E., Higgins, R. S., Butler, C. E., & Offodile, A. C. (2021). Assessment of costs and care quality associated with major surgical procedures after implementation of Maryland’s capitated budget model. JAMA Network Open, 4(9), e2126619. https://doi.org/10.1001/jamanetworkopen.2021.26619
Etemad-Rezaie, A., Yang, S., Kirklys, M., Higginbotham, D. O., Zalikha, A. K., & Nasr, K. (2022). Single-incision fasciotomy for acute compartment syndrome of the leg: A systematic review of the literature. Journal of Orthopaedics, 31, 134–139. https://doi.org/10.1016/j.jor.2022.04.014
Sraj, S., Henderson, J. T., Bramer, M. A., & Gelman, J. (2022). Principles of fasciotomy closure after compartment syndrome release. Journal of the American Academy of Orthopaedic Surgeons, 30(18), 879–887. https://doi.org/10.5435/jaaos-d-21-01046
Torlincasi, A. M. (2023, January 16). Acute compartment syndrome. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK448124/
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