筋膜切開、筋膜切開術

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/10/10 18:35:14」(JST)

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When the pressure is down, the fasciotomy is covered with a skin graft.

Fasciotomy or fasciectomy is a surgical procedure where the fascia is cut to relieve tension or pressure commonly to treat the resulting loss of circulation to an area of tissue or muscle.^[1] Fasciotomy is a limb-saving procedure when used to treat acute compartment syndrome. It is also sometimes used to treat chronic compartment stress syndrome. The procedure has a very high rate of success, with the most common problem being accidental damage to a nearby nerve.

A forearm fasciotomy prior to skin grafting.

Complications

A delay in performing the procedure can lead to neurovascular complications or lead to the need for amputation of a limb.^[1] Complications can also involve the formation of scar tissue after the operation. A thickening of the surgical scars can result in the loss of mobility of the joint involved. This can be addressed through occupational or physical therapy.

Process

Fasciotomy in the limbs is usually performed 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.

Plantar fasciotomy is an endoscopic procedure. The physician makes two small incisions on either side of the heel. An endoscope is inserted in one incision to guide the physician. A tiny knife is inserted in the other. A portion of the fascia near the heel is removed. The incisions are then closed.

Wound covered with a skin graft once pressure is relieved.

In addition to scar formation, there is a possibility that the surgeon may need to use a skin graft to close the wound. Sometimes when closing the fascia again in another surgical procedure, the muscle is still too large to close it completely. A small bulge is visible, but is not harmful. It takes much time to heal and in some cases takes several months.

Indications

Compartment syndrome is one of the conditions where a fasciotomy may be indicated. People who are likely to suffer injuries needing a fasciotomy include the following:

Victims of vehicular accidents or crush injuries^[2]
Athletes who have sustained one or more serious impact injuries
People with severe burns
Persons who are severely overweight

References

^ ^a ^b Dente CJ, Wyrzykowski AD, Feliciano DV (October 2009). "Fasciotomy". Current Problems in Surgery 46 (10): 779–839. doi:10.1067/j.cpsurg.2009.04.006. PMID 19735797. Retrieved 2012-07-30.
^ "Compartment syndrome: MedlinePlus Medical Encyclopedia". Nlm.nih.gov. Retrieved 2014-03-08.

UpToDate Contents

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1. 下肢の筋膜切開法 lower extremity fasciotomy techniques
2. 四肢筋膜切開後の患者のマネージメント patient management following extremity fasciotomy
3. 四肢の急性コンパートメント症候群 acute compartment syndrome of the extremities
4. 手熱傷の一次外科的マネージメント primary operative management of hand burns
5. 重度の四肢外傷の外科的マネージメント surgical management of severe extremity injury

English Journal

Compartment Syndrome in Children: Diagnosis and Management.

Hosseinzadeh P1, Talwalkar VR.
American journal of orthopedics (Belle Mead, N.J.).Am J Orthop (Belle Mead NJ).2016 Dec;45(1):19-22.
Compartment syndrome (CS) can present differently in children than in adults. Increased need for analgesics is the first sign of evolving CS in children. Children with supracondylar humeral fractures, floating elbow injuries, operatively treated forearm fractures, and tibial fractures are at high ri
PMID 26761913

Development of a Burn Escharotomy Assessment Tool: A Pilot Study.

Ur R1, Holmes JH 4th, Johnson JE, Molnar JA, Carter JE.
Journal of burn care & research : official publication of the American Burn Association.J Burn Care Res.2016 Mar-Apr;37(2):e140-4. doi: 10.1097/BCR.0000000000000322.
Severe burn injuries can require escharotomies which are urgent, infrequent, and relatively high-risk procedures necessary to preserve limb perfusion and sometimes ventilation. The American Burn Association Advanced Burn Life Support© course educates surgeons and emergency providers about escharoto
PMID 26594860

Thigh compartment syndrome complicated by sciatic nerve palsy, rhabdomyolysis, and acute renal failure.

Alobaidi A1, Backdash MM1, El-Menyar A2.
Clinical case reports.Clin Case Rep.2015 Nov 19;4(2):107-10. doi: 10.1002/ccr3.446. eCollection 2016.
We reported a rare case of thigh compartment syndrome (TCS) complicated by sciatic nerve palsy, rhabdomyolysis, and acute renal failure in an alcoholic patient. Intensive care measures and immediate posteromedial decompressive fasciotomy were performed. These timely interventions resulted in improve
PMID 26862401

Japanese Journal

筋区画内圧測定,減張切開 (特集救急処置のトラブルとリカバリー)

筧裕香子
救急医学 = The Japanese journal of acute medicine 38(6), 697-700, 2014-06
NAID 40020123068

症例軽微な外傷後に生じた長腓骨筋断裂による下腿外側コンパートメント症候群の1例

浅野研一,三重野琢磨
整形・災害外科 57(3), 331-333, 2014-03
NAID 40020003986

コンパートメント症候群の診断・治療選択に近赤外線分光法が有効であった2症例

鴛渕るみ,若松弘也,松田憲昌,松本聡,松本美志也
蘇生 33(1), 21-25, 2014
　コンパートメント症候群は，筋区画内圧測定により診断・治療を行う。筋区画内で適切な血液の潅流によって酸素運搬が行われることが重要であり，そのモニターとして，近赤外線分光法（near-infrared spectroscopy：NIRS）により筋区画内の局所酸素飽和度（regional saturation of oxygen：rSO2）を測定することは，理にかなった方法である。減張切開が必要となっ …
NAID 130004561997