![]() ![]() Male patients, younger patients, patients with depression, and patients with deep posterior compartment involvement may serve to benefit more with fasciotomies for treatment of CECS.įoot and Ankle Ability Measure (FAAM) chronic exertional compartment syndrome (CECS) operative patient outcomes visual analog scale (VAS). Multiple linear regression analysis revealed deep posterior compartment involvement, younger age, a history of depression, and male sex to be significant independent predictors of enhanced improvement after fasciotomy.įasciotomy is an effective treatment of CECS, with our study identifying certain patient variables leading to greater functional improvement. Patients had a mean ± SD improvement in FAAM-Sports of 40.4 ± 22.3 points ( P < 0.001), improvement in FAAM-Sports SANE of 57.3 ± 31.6 points ( P < 0.001), and reduction of VAS pain of 56.4 ± 31.8 points ( P < 0.001). Generalized multiple linear regression analyses was performed to determine independent predictors of functional and pain improvement.Ī total of 61 patients (58% response rate) who underwent 65 procedures were included in this study, with postoperative outcome measures obtained at mean duration of 57.9 months (range, 12-115 months) after surgery. ![]() The primary outcomes of change in FAAM-Sports, FAAM-Sports SANE, and VAS during sporting activities were calculated by taking the difference of post- and preoperative scores. Pre- and postoperative measures of Foot and Ankle Ability Measure-Sports subscale (FAAM-Sports), FAAM-Sports Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain during sporting activities were collected at a minimum of 12 months postoperatively. Specific patient variables will lead to enhanced functional improvement after fasciotomy for CECS of the lower extremity.Ī review of patients undergoing fasciotomy of the lower extremity for treatment of CECS by a single surgeon from 2009 to 2017 was performed. However, not all patients have demonstrated the same level of symptom improvement. 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.Previous studies have demonstrated the effectiveness of lower extremity fasciotomies in treating chronic exertional compartment syndrome (CECS). The dangerously high pressure in compartment syndrome impedes the flow of blood to and from the affected tissues. Compartment syndrome usually results from bleeding or swelling after an injury. ![]() The tough walls of fascia cannot easily expand, and compartment pressure rises, preventing adequate blood flow to tissues inside the compartment. Compartment syndrome occurs when excessive pressure builds up inside an enclosed muscle space in the body. Strong webs of connective tissue called fascia form the walls of these compartments. Groups of organs or muscles are organized into areas called compartments. The ICD-10-PCS Official Guidelines for Coding and Reporting, Multiple Procedures, Section B3.2b, state, “During the same operative episode, multiple procedures are coded if: The same root operation is repeated in multiple body parts, and those body parts are separate and distinct body parts classified to a single ICD-10-PCS body part value.” Clinical Information: The ICD-10-PCS code can be assigned multiple times for each compartment released (i.e., two compartment fasciotomy, four compartment fasciotomy, etc.). In this case, the fasciotomy meets the root operation definition of “Release ” freeing a body part from an abnormal physical constraint by cutting or by using force. What PCS code(s) are assigned for this procedure? Answer:ĠKNT0ZZ Release left lower leg muscle, open approachĠKNT0ZZ Release left lower leg muscle, open approach Rationale: Anterolateral incision was then made and carried down through the fascia anterolaterally with opening of the fascia on the anterior as well as the lateral compartment. Muscle in these compartments was contractile. With this information, we proceeded with fasciotomy medially decompressing the superficial as well as the deep posterior compartments. For the anterior and lateral compartments the measurement was 32, for the posterior compartment superficial and deep, it was 34. Procedure: The compartment pressures of the patient’s four compartments were measured. Postoperative diagnosis: status post polytrauma left lower extremity status post motorcycle accident with elevated compartment pressure for the lateral as well as the medial compartments. In a study of patients with clinical signs of compartment syndrome after revascularization surgery for lower limb ischemia, Arato et al reported that measurement of intracompartmental pressure and tissue oxygenation (measured with near-infrared spectroscopy) could be used to determine whether fasciotomy was needed. Fasciotomy for Compartment Syndrome Scenario: ![]()
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