Role of OR Technician in Foot Fasciotomy
The OR technician plays a critical role in assisting surgeons during foot fasciotomy procedures by preparing specialized instruments, anticipating surgical needs, and facilitating efficient compartment release to prevent devastating complications from compartment syndrome.
Preoperative Responsibilities
Instrument preparation: Set up specialized instruments for fasciotomy including:
- Scalpels (#10 and #15 blades)
- Metzenbaum scissors
- Retractors (self-retaining and handheld)
- Hemostatic instruments (clamps, electrocautery)
- Measuring devices for compartment pressure assessment
- Negative pressure wound therapy equipment
Patient positioning: Assist in proper positioning of the patient's foot to allow optimal access to all compartments requiring release
Sterile field maintenance: Establish and maintain sterile field with particular attention to the foot and lower extremity
Intraoperative Support
Instrument handling: Anticipate surgeon's needs during critical steps of compartment release, especially when compartment pressure exceeds 30 mmHg 1
Surgical approach assistance: Support surgeon during specific approaches:
- Two dorsal incisions for forefoot compartments
- Medial incision for calcaneal, medial, superficial, and lateral compartments 1
Monitoring equipment: Assist with setup and operation of compartment pressure monitoring devices when measurements are required
Specimen management: Properly handle and label any tissue specimens obtained during the procedure
Documentation: Record instrument counts, procedure details, and any special considerations
Post-Fasciotomy Support
Wound management: Assist with application of negative pressure wound therapy (NPWT), which is recommended as first-line therapy for Grade 1 and 2 open fasciotomy wounds 1
Dressing application: Help prepare and apply appropriate dressings to maintain wound exposure while preventing contamination
Closure preparation: When delayed primary closure is planned, assist with preparation of vessel loops or plastic bands for gradual wound approximation 2
Special Considerations
Emergency procedures: Be prepared for bedside fasciotomy under local anesthesia in urgent cases where operating room delays could compromise outcomes 3
Equipment for reperfusion monitoring: Have equipment ready to monitor for reperfusion syndrome following fasciotomy in cases of acute limb ischemia 4
Timing awareness: Understand that fasciotomy is most effective when performed early, as benefits decrease significantly when performed after 8 hours of increased compartment pressure 4
Technical Pearls
Ensure all necessary equipment for measuring compartment pressures is immediately available, as diagnosis is confirmed when pressure exceeds 30 mmHg 1
Be prepared for potential extension of the procedure if initial fasciotomy does not adequately reduce compartment pressure
Anticipate the need for blunt dissection of interosseous muscles and separate fasciotomy of medial, lateral, and plantar compartments based on intraoperative pressure measurements 5
Have wound closure materials ready, as fasciotomy wounds may require specialized closure techniques or delayed primary closure 2
By understanding these responsibilities and being prepared for the specific needs of foot fasciotomy procedures, OR technicians can significantly contribute to successful surgical outcomes and help prevent the devastating consequences of untreated compartment syndrome.