Long incisions are made through the skin and the fascia (tough membrane surrounding the muscle compartments). In the lower leg, two incisions release all four compartments. In the forearm, a single volar incision releases the volar compartment, with a dorsal incision if needed. The wounds are left open (not stitched) to allow the muscles to swell without restriction. The wounds are covered with negative pressure dressings. Delayed wound closure, skin grafting, or gradual closure is performed days later once swelling settles. The initial fasciotomy takes 30–60 minutes.
Fasciotomy is an emergency for confirmed or clinically suspected compartment syndrome. It is most common after tibial fractures, forearm fractures, high-energy injuries, crush injuries, and reperfusion after vascular repair. Delay of more than six to eight hours from onset causes irreversible muscle death and nerve damage.
There are no non-operative alternatives for established compartment syndrome. It is a surgical emergency.
This is an emergency requiring immediate surgery. The diagnosis is clinical — severe pain out of proportion to the injury, pain on passive stretch of the muscles, and tense compartments. Compartment pressure monitoring may support the diagnosis but must not delay surgery.
Prevention of muscle death and nerve damage. When performed within six hours of onset, outcomes are generally good. Delayed fasciotomy has a much worse prognosis, with risk of permanent muscle contracture (Volkmann's ischaemic contracture in the forearm) and amputation.
Open woundsExpected
The fasciotomy wounds are left open and require further procedures for closure.
ScarringExpected
Significant scarring from long incisions.
Muscle weaknessCommon
Some muscle damage may have occurred before fasciotomy.
Nerve dysfunctionCommon
Nerve damage from the compartment syndrome itself, not from the surgery.
Skin graftingCommon
May be needed if wounds cannot be closed directly.
Irreversible muscle deathUncommon
If fasciotomy is too late, muscle may not recover (rhabdomyolysis).
Renal failureUncommon
From myoglobin release (rhabdomyolysis) damaging the kidneys.
AmputationRare
In severe cases with extensive muscle death.
InfectionUncommon
Open wounds are at risk.
Volkmann's contractureRare
Permanent forearm contracture from delayed or missed compartment syndrome.
General anaesthesia. Emergency surgery — no delay for fasting or optimisation.
The wounds are managed with negative pressure dressings, changed every two to three days. Wound closure or skin grafting at five to seven days once swelling settles. Physiotherapy for muscle and joint rehabilitation begins as soon as possible. Full recovery depends on the severity of muscle damage — weeks to months.
Daily wound assessment until closure. Physiotherapy throughout. Renal function monitoring. Long-term follow-up for muscle and nerve recovery.
Why was this done as an emergency?
Compartment syndrome causes irreversible muscle and nerve death within six to eight hours. Every minute counts. Fasciotomy must be performed as soon as the diagnosis is suspected — waiting for confirmatory tests is not appropriate.
Why are the wounds left open?
The purpose of fasciotomy is to release pressure. Closing the wounds immediately would negate the decompression. The wounds are closed once swelling has settled, typically at five to seven days.
Will I recover full function?
This depends on how quickly fasciotomy was performed and the extent of muscle damage. Early fasciotomy generally leads to good recovery. Delayed fasciotomy has a worse prognosis.