Fasciotomy Anyone

**cspringsposer** · 02-05-2022, 09:31 AM

Took a bad crash and currently in the hospital. Not totally sure what the extent of the damage is but I know I have a broken tub/fib, reconstructed knee and had an emergency fasciotomy. I have broken bones and torn ligaments before, but never had a fasciotomy. Anyone here have experience with this procedure and know what recovery looks like? They aren't telling me much at the hospital right now and am just hoping for some beta on fasciotomy recovery.

**bio-smear** · 02-05-2022, 09:48 AM

Sounds like it's to prevent or relieve compartment syndrome? You do not want that for sure as it puts the limb in jeopardy. Was the fracture compound or in need of reconstruction and hardware? Did your surgeon say it was a preventative measure or responsive?

Not a doc, but I'm sure one will chime in. Hang in there and ++++ vibes ++++, man.

**abraham** · 02-05-2022, 10:13 AM

Good luck. Sounds like a gnarly injury fun the other thread. I found a few links from here in the gimp forum for you. There's one I remember for a long time ago that I can't find right now, unfortunately.
https://www.tetongravity.com/forums/...d.php?t=238696
https://www.tetongravity.com/forums/...d.php?t=259630
https://www.tetongravity.com/forums/...d.php?t=287968

**cspringsposer** · 02-05-2022, 12:00 PM

Thanks. I had severe compartment syndrome in the lower leg and they said they had to do the emergency fasciotomy to "save the leg". Along with rebuilding the knee, I had plates and screws put in. Not quite sure how many or where at this point, but I know I got some hardware.

**John_B** · 02-05-2022, 12:28 PM

Good luck with your recovery man! I bet you'll be back out on skis at some point next year.

Edit: Here is a very in-depth and well written blog about a accomplished climber's recovery from a tib/fib, serious artery damage and compartment syndrome. She had some serious setbacks and a very slow recovery but has been back climbing at a high level and doesn't appear to be struggling too much with the issues she had. I don't know her at all but get the impression she's the type of person that would respond to you if you've got some recovery questions as you get further along.

https://www.stephabegg.com/tripreports/recovery

**skinipenem** · 02-05-2022, 12:30 PM

Originally Posted by cspringsposer

Thanks. I had severe compound syndrome in the lower leg and they said they had to do the emergency fasciotomy to "save the leg". Along with rebuilding the knee, I had played and screws out in. Not quite sure how many at this point, but I know I got some hardware.

Compartment syndrome... you're on drugs.

Heal up soon and vibes.

I'm not an orthopedist; however, I think the faciotomy will be the least of your worries. Motocross and off road racers get faciotomies to releive arm pump so they can go faster.

Sent from my SM-G998U using Tapatalk

**cspringsposer** · 02-05-2022, 12:46 PM

Originally Posted by John_B

Good luck with your recovery man! I bet you'll be back out on skis at some point next year.

Edit: Here is a very in-depth and well written blog about a accomplished climber's recovery from a tib/fib, serious artery damage and compartment syndrome. She had some serious setbacks and a very slow recovery but has been back climbing at a high level and doesn't appear to be struggling too much with the issues she had. I don't know her at all but get the impression she's the type of person that would respond to you if you've got some recovery questions as you get further along.

https://www.stephabegg.com/tripreports/recovery

Thanks brother! That is awesome. I have been looking but there doesn't seem to be much out there about this specific injury/syndrome.

**cspringsposer** · 02-05-2022, 12:47 PM

Originally Posted by skinipenem

Compartment syndrome... you're on drugs.

Heal up soon and vibes.

I'm not an orthopedist; however, I think the faciotomy will be the least of your worries. Motocross and off road racers get faciotomies to releive arm pump so they can go faster.

Sent from my SM-G998U using Tapatalk

Yup, definitely on lots of drugs. Thanks for the correction.

**old goat** · 02-05-2022, 09:08 PM

I've never had a fasciotomy but I've done them. What skinipenem* said. The fracture and knee reconstruction will be the issue for you. The cuts in the fascia won't interfere with the function of your leg or require any healing.

Did they have to make any long incisions in the leg to fix the fractures? If so they may have left the incisions open if there was a lot of swelling and that could possibly take a while to heal or even require a skin graft. Did they put any hardware in the leg that comes out through the skin? Called and external fixator--it's basically steel rods that hold the pieces together when the bone is too shattered to just plate it together.

Fascia is a very tough, inelastic membrane that covers muscles. In the leg it divides the muscles into 4 compartments. With a bad injury the muscles swell but can't expand because of the fascia and so pressure builds up in the compartments squeezing and damaging the nerves and blood vessels. By cutting the fascia in all the compartments the muscles can expand outward instead of squeezing the nerves and vessels.

*Imipenem is a very fancy antibiotic that required an infectious diseases doc to approve before dumb surgeons could give it, in my hospital. Skimipenem must be and ID doc?

**cspringsposer** · 02-05-2022, 11:40 PM

Thanks Old Goat. I think I must have a different faciotomy than what you are talking about. Mine are one long cut from right below the knee to above the ankle on both sides and the muscles came out the cuts (I regret looking at it when they changed my gauze). They are still open and they said I will need skin grafts to close them up in the coming weeks.

When I got to the hospital they jammed a large needle attached to a gauge/measuring device into my calf and shin muscles. I had readings in the upper 70s on both sides of the leg. I have no idea what those numbers mean but this was the point things started happening very quickly and they rushed me straight to CT scan and then right into the OR. They said I had a severe acute compartment syndrome in the lower leg and if the fasciotomy wasn't done within 6 hours of the injury the calf and leg would be at risk of loss. Next thing I knew I was waking up in the recovery room.

I am very familiar with broken bones and torn ligaments, but this fasciotomy and skin grafts are something I don't know much about and the nurses haven't had experience with it either to tell me what to expect. The link John_B posted is the most information I have been able to find about the process so far.

**old goat** · 02-06-2022, 03:22 PM

fasciotomy can be done through small incisions or through long incisions as in your case. My guess is that they used the long incisions because they felt it was urgent to get a more complete fasciotomy. Your compartment pressures were several times higher than normal (15-30 depending on who you ask). It sounds like you had a standard 4 compartment fasciotomy. The muscle bulging out is normal and should go back down as the swelling goes down, but the skin edges will remain separated which is why you will need skin grafts. The fasciotomy itself shouldn't cause any long term problem or delay in healing but there could be nerve or blood vessels damage from the high compartment pressures before the fasciotomy and from the fracture itself. The skin grafting itself is relatively straightforward and should heal pretty quickly. As I said before your recovery will depend on the healing of the fracture and on any nerve or vessel damage from the high pressures. You will need a lot of rehab.

Do you know if your knee was dislocated?

**cspringsposer** · 02-06-2022, 03:42 PM

That all makes sense. I have a fractured patella but don't know if it was dislocated. This is what it looked like about an hour after the accident when we were driving to the hospital. Not sure if that shows you anything or not.

**old goat** · 02-06-2022, 05:29 PM

I was thinking about the knee itself being dislocated. I'm sure they would have told you if it had been. The reason I ask is because you mentioned they reconstructed your knee, which can mean a lot of things. Knee dislocation can block the artery to the lower leg. Nothing for you to worry about at this point--you have enough to worry about as it is. Heal up please.

**cspringsposer** · 02-06-2022, 05:41 PM

Thank you sir. I appreciate the information and words of support. It seems like I find out about another injury everytime a surgeon comes in to check on me. I am really ready to get out of this hospital!

**skinipenem** · 02-06-2022, 06:09 PM

Originally Posted by cspringsposer

Thank you sir. I appreciate the information and words of support. It seems like I find out about another injury everytime a surgeon comes in to check on me. I am really ready to get out of this hospital!

Sounds like Old Goat has got it right, about your situation thus far.

@oldgoat Close on my username.

some day when our paths cross I'll share in person... more fun to have the mystery live in the interwebs.

In all seriousness, cspringposer I wish you a speedy convalescence. Hopefully, no permanent neural damage. Mostly everything else can be fixed.

Vibes man. This is going to be a long process to recovery. Get yourself prepared.

Sent from my SM-G998U using Tapatalk

**Dantheman** · 02-06-2022, 06:55 PM

You should check out the movie The Other Side of Fear about big wave surfer Mark Matthews' recovery from a complete knee dislocation that resulted in major nerve damage and compartment syndrome. The nerve damage was specific to his injury so your recovery is likely to go better, but you definitely have a long road ahead that's likely to be more similar than not. Either way it's a good movie and you have time to kill. It's available free on Red Bull TV.

Good luck.

**cspringsposer** · 02-06-2022, 10:44 PM

Thank you. I will look it up when I get home. Sounds interesting and there really isn't a whole lot of info on CS that I can find.

**John_B** · 02-11-2022, 04:10 PM

How are things going for ya?

**cspringsposer** · 02-11-2022, 06:48 PM

Hanging in there brother. They closed the fasciotomy and I am out of the hospital. Sounds like I get to start using the leg and learning how to walk in about 3 months. Things are definitely looking up. Thanks for checking in.

**skinipenem** · 02-12-2022, 05:11 AM

Originally Posted by cspringsposer

Hanging in there brother. They closed the fasciotomy and I am out of the hospital. Sounds like I get to start using the leg and learning how to walk in about 3 months. Things are definitely looking up. Thanks for checking in.

Keep up the positive attitude! Like the terminator: You'll be back!

In the meantime find a great bootfitter. You'll likely need one next fall.

Sent from my SM-G998U using Tapatalk

**old goat** · 02-12-2022, 10:03 AM

I'm impressed they were able to close the fasciotomy. The swelling must have gone down pretty quickly. That you're out of the hospital so soon is very promising. Best of luck with your recovery.

**cspringsposer** · 02-12-2022, 10:19 AM

Originally Posted by skinipenem

Keep up the positive attitude! Like the terminator: You'll be back!

In the meantime find a great bootfitter. You'll likely need one next fall.

Sent from my SM-G998U using Tapatalk

Thanks for the encouragement!

I am definitely staying positive. The alternative is drunken depression, which I have gone through with other injuries. Being older and having experience with prior injuries, I am not drinking and staying very positive.

**cspringsposer** · 02-12-2022, 10:22 AM

Originally Posted by old goat

I'm impressed they were able to close the fasciotomy. The swelling must have gone down pretty quickly. That you're out of the hospital so soon is very promising. Best of luck with your recovery.

Surgeon was also surprised the pressures went down and stabilized so quickly. There is a very good chance I might not need skin grafts. The pain level is still really high - more than I expected it to be at this point. The worst pain is the calf muscle and the bones - especially where the hardware is attached.

As always OG, thanks for sharing your knowledge and for encouraging us gimps!