Thursday, March 13, 2014

First post op follow up

I now have more empathy for my patients after my follow up yesterday with the surgeon. He deemed my leg "hypersensitive" after demonstrating how to perform a deep massage to the anterior compartment. I then cried like a baby in front of everyone. The good news? My incisions look awesome! Below are some pictures before and after they were cleaned up and the steri strips were changed.
 Distal incision before getting cleaned. 

Both incisions prior to getting cleaned; steri strips on. 

 Both incisions after getting cleaned up; new steri strips.

Smiling after getting cleaned up. This was after wiping away all the tears. 

Monday, March 10, 2014

My experience with chronic/exertional compartment syndrome and compartment release/fasciotomy

Disclaimer: Please do not use my experiences to diagnose yourself or someone else. If you think you have compartment syndrome please see your primary care provider or orthopedist.

I was starting to give up the idea of ever running again when I spoke with two of my former classmates whom suggested I may have compartment syndrome.  I immediately scheduled a follow up with my orthopedist to see if this was the case and what to do about it.

There are two forms of compartment syndrome: acute and chronic. Acute compartment syndrome normally occurs following a traumatic injury.  The injury causes swelling in the compartment.  The fascia around the compartment is not flexible and does not allow any relief of the pressure. This is a medical emergency and is treated with a fasciotomy.  This is an incision along the length of the skin and fascia to relieve the pressure. The second type of compartment syndrome is chronic or exertional compartment syndrome. This is often seen in athletes of repetitive sports (think running, cycling). There are multiple theories regarding what causes chronic or exertional compartment syndrome.  Some of these are biomechanics, tight or adhered fascia, or poor venous return. Most research shows that the best treatment for chronic exertional compartment syndrome is a fasciotomy.  However, it is recommended to try conservative treatment first (stretching, physical therapy). The fasciotomy or compartment release for chronic exertional compartment syndrome is not as invasive as that performed for acute compartment syndrome.

A diagnoses of chronic compartment syndrome is based based on history, symptoms and signs during a physical exam. My symptoms were pain in my lower leg and sometimes in my foot during the following activities: walking, running, stationary bike or cardio on the elliptical machine at the gym. If left untreated, the swelling in the compartment can cause compromise to nerves, muscles and arteries (ie.numbness, tingling, paralysis, tissue death).

A pressure compartment test is the "gold standard" for diagnosing compartment syndrome. For chronic compartment syndrome, the pressure in the compartment is taken pre and post exercise (1 minute after and then again 5 minutes after).  A large needle is stuck into the compartment and then a catheter is inserted to test the pressure.  My pressure was elevated at rest and then increased with exercise. This along with the clinical signs I exhibited confirmed my diagnosis of chronic compartment syndrome.

Since I had failed conservative treatment (physical therapy, stretching, taping, etc.), I decided to have the fasciotomy.

I am now one week post op.  The pain has been tolerable for the most part. I am now able to walk from one room to another in the apartment without crutches if my pain is managed. I am starting to wear the walking boot as that is what I will need to wear to return to work later this week.  The boot puts a lot of pressure on the incisions and I can not wear it for very long.  This is only the second day that I have tried wearing it. Initially after surgery I was put in a splint. However, I had that removed the day after surgery because it was putting too much pressure on my heel which caused pain and burning. The incisions look great (from what I can see; they are covered with steri strips) and I am just starting to have bruising throughout the front of my leg.

Below are some pictures of the incisions. If you are squeamish don't look. I don't think they are too graphic, but I work in health care and am somewhat desensitized to seeing clean, intact wounds. A word of warning: I wouldn't google image or video search "fasciotomy" unless you want to upset your stomach.  I have watched half a dozen surgeries and see post op incisions frequently at work, however some of the pictures and video that come up regarding faciotomies are quiet graphic (especially if you are thinking of having the surgery done!).  (Do keep in mind that most of them are for acute compartment syndrome and the surgery is much more invasive than that for chronic compartment syndrome.)

 Hanging out on the couch. Day of Surgery (DOS).
 Distal incision POD # 1. Taken just after getting the splint taken off.
Elevating my leg on the patio while enjoying the view.

As far as recovery goes, it will be a full 3 months until I am able to "return to sport," which for me is running. I will be able to bike and eventually do the elliptical prior to that 3 month mark. I will try to keep this updated throughout my recovery process.  Check the labels for "compartment syndrome" and "fasciotomy" and hopefully (this summer!) under "run"!