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Nakayama Y, Yamaguchi M, Inoue K, Sasaki M, Tamaki K, Hidaka M. Well-leg compartment syndrome after laparoscopic low anterior resection in the lithotomy position: a case report and literature review. J Surg Case Rep 2024; 2024:rjae206. [PMID: 38572283 PMCID: PMC10988823 DOI: 10.1093/jscr/rjae206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Well-leg compartment syndrome (WLCS) develops in healthy lower limbs because of surgical factors such as operative position, lower limb compression, and long operative time during abdominopelvic surgery. WLCS can lead to irreversible muscle and nerve damage if a prompt diagnosis and appropriate treatment are not provided. We report the case of a 57-year-old male who developed rectal cancer immediately after laparoscopic low anterior resection and was successfully treated with fasciotomy without sequelae. Patients who undergo surgery in the lithotomy position for a prolonged period are at risk of WLCS. Therefore, when determining the differential diagnosis of postoperative lower leg pain, it is necessary to consider WLCS because it is a complication caused by the intraoperative position.
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Affiliation(s)
- Yoko Nakayama
- Department of Surgery, Oda Municipal Hospital, 1428-3 Oda-cho Yoshinaga, Oda, Shimane 694-0063, Japan
| | - Minekazu Yamaguchi
- Faculty of Medicine, Department of General Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Keisuke Inoue
- Faculty of Medicine, Department of Digestive and General Surgery, Shimane University, 89-1, Enya-cho, Izumo City, Shimane 693-8501, Japan
| | - Masaki Sasaki
- Department of Surgery, Oda Municipal Hospital, 1428-3 Oda-cho Yoshinaga, Oda, Shimane 694-0063, Japan
| | - Kaho Tamaki
- Department of Surgery, Oda Municipal Hospital, 1428-3 Oda-cho Yoshinaga, Oda, Shimane 694-0063, Japan
| | - Masaaki Hidaka
- Faculty of Medicine, Department of Digestive and General Surgery, Shimane University, 89-1, Enya-cho, Izumo City, Shimane 693-8501, Japan
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Yukizawa Y, Kamono E, Takagawa S, Hirotomi K, Higashihira S, Choe H, Inaba Y, Kobayashi N. Evaluation of the Postoperative Risk of Deep Tissue Injury to the Lower Extremities Following Surgery in the Lithotomy Position. Cureus 2024; 16:e57413. [PMID: 38694644 PMCID: PMC11062756 DOI: 10.7759/cureus.57413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 05/04/2024] Open
Abstract
Background The aim of this study was to determine the incidence of deep tissue injury (DTI) and potential risk factors after surgery in the lithotomy position. Methods All patients who underwent surgery in the lithotomy position under general anesthesia at a single center between January 2017 and December 2021 were retrospectively evaluated. The medical records of these patients were reviewed, and patient demographic and clinical characteristics, surgical data, and occurrence of DTI were recorded. Results During the study period, 5146 patients, 2055 (39.9%) males and 3091 (60.1%) females, with a mean age of 57.3 ± 17.4 years, underwent surgery in the lithotomy position. Seven (0.14%) patients developed DTI on their calf following surgery. All presented with severe pain and swelling, requiring prolonged hospital stay. Multivariate analysis showed that male sex (odds ratio (OR): 11.43; 95% confidence interval (CI): 1.15-113.34, p = 0.037), higher BMI (OR: 1.32; 95% CI: 1.17-1.50, p = 0.0001), and longer operation time (OR: 1.01; 95% CI: 1.004-1.014, p = 0.0002) were independent risk factors for postoperative DTI. Optimal cut-off values for BMI and operation time were 23.5 kg/m2 (sensitivity = 100%; specificity = 64%) and 285 minutes (sensitivity = 100%; specificity = 90%), respectively. Conclusion Factors significantly associated with DTI include male sex, higher BMI, and prolonged operation time.
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Affiliation(s)
- Yohei Yukizawa
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Emi Kamono
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Shu Takagawa
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Kunihito Hirotomi
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Shota Higashihira
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Hyonmin Choe
- Orthopaedic Surgery, Yokohama City University, Yokohama, JPN
| | - Yutaka Inaba
- Orthopaedic Surgery, Yokohama City University, Yokohama, JPN
| | - Naomi Kobayashi
- Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
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Susanne J, Åsa H. Preventing well leg compartment syndrome among patients in the lithotomy position-Operating room nurses' perspectives: A qualitative study. Nurs Open 2023; 10:7092-7101. [PMID: 37571958 PMCID: PMC10495710 DOI: 10.1002/nop2.1971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
AIM To describe operating room nurses' experiences of well leg compartment syndrome and how they work perioperative to prevent it during the lithotomy position. DESIGN The study had a qualitative design. METHODS Focus group interviews were performed with 10 operating room (OR) nurses. The interviews were semi-structured and analysed by qualitative content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS The main theme showed that the OR nurses shoulder duty and responsibility, independently and in the team, but they need more structural support and knowledge. The themes showed that they follow routines whenever possible and take responsibility for positioning; however, they have to balance between flexibility and strict routines. Although they also develop and participate in teamwork, they still need further knowledge. CONCLUSION The severe complication of well leg compartment syndrome (WLCS) can occur when the patient is in the lithotomy position. Maintaining the same routines and paying attention to the WHO's surgical safety checklist were described as actions that could prevent well leg compartment syndrome. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. We have interviewed nurses but without financial support since the study was performed and supervised within a master programme.
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Suzuki K, Sakata M, Tatsuta K, Sugiyama K, Akai T, Suzuki Y, Kawamura T, Torii K, Morita Y, Kikuchi H, Hiramatsu Y, Fukazawa A, Yamamoto M, Kurachi K, Sakaguchi T, Takeuchi H. Analysis of external pressure on the left calf in the Lloyd-Davies position during colorectal surgery. Surg Today 2023; 53:145-152. [PMID: 35900468 DOI: 10.1007/s00595-022-02549-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Well-leg compartment syndrome (WLCS) is a potentially life-threatening postoperative complication related to the Lloyd-Davies surgical position, which can place increased external pressure on the calf region. We conducted this study to analyze external pressure changes, by applying a leg holder system to the left calf region of patients placed in the Lloyd-Davies position during laparoscopic surgery. METHODS The study participants were 50 patients who underwent laparoscopic surgery for colorectal cancer in the Lloyd-Davies position. We assessed the maximum external pressure (MEP) on the left calf region using a pressure-distribution measurement system. Intraoperative measurements were taken continuously, and the MEP was evaluated with the patient horizontal and every 30 min during surgery in the head and right-down tilt position. RESULTS The intraoperative MEP increased gradually when the patient was in the head and right-down tilt position and decreased when the patient was returned to the horizontal position. The MEP was higher in patients aged < 60 years, those who were obese, and those with a thick calf circumference. Both body mass index (BMI) and the maximum left calf circumference (MLCC) were found to correlate with the MEP. CONCLUSIONS In addition to a high BMI, which is a well-known risk factor for WLCS, a high MLCC should be considered another risk factor, especially for patients under 60 years.
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Affiliation(s)
- Katsunori Suzuki
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Mayu Sakata
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Kyota Tatsuta
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Kosuke Sugiyama
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Toshiya Akai
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Yuhi Suzuki
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Takafumi Kawamura
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Kakeru Torii
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yoshifumi Morita
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Hirotoshi Kikuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Yoshihiro Hiramatsu
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Atsuko Fukazawa
- Department of Gastroenterological Surgery, Iwata City Hospital, Iwata, Shizuoka, Japan
| | - Masayoshi Yamamoto
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Kiyotaka Kurachi
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
| | - Takanori Sakaguchi
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.,Department of Gastroenterological Surgery, Iwata City Hospital, Iwata, Shizuoka, Japan
| | - Hiroya Takeuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
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Mizuno J, Iijima S, Takahashi T. Lower leg blood pressure decreases while calf external pressure increases with the angulation of the Trendelenburg position in the lithotomy position with calf- and foot-supported leg holders. J Robot Surg 2022. [DOI: 10.1007/s11701-022-01481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/16/2022] [Indexed: 11/24/2022]
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Nester M, Borrelli J. Well Leg Compartment Syndrome: Pathophysiology, Prevention, and Treatment. J Clin Med 2022; 11:6448. [DOI: 10.3390/jcm11216448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
The development of compartment syndrome involving the lower limb is a potentially devastating complication of prolonged surgery in patients held in the lithotomy position. Well leg compartment syndrome (WLCS) was recognized in 1953. The incidence of this condition has been reported to range from 0.20% to 0.03%. The mechanism of WLCS development in the absence of trauma appears to be related to prolonged hypoperfusion of the limb, pressure on the muscle compartments, and in some cases, reperfusion of the ischemic limb. This grave complication develops either during or immediately after prolonged surgery in which the patient was held in the Lloyd-Davies lithotomy or hemi-lithotomy position. Surgeons must be aware of the potential for WLCS development during prolonged surgery. Signs of developing WLCS include swelling, increased firmness of the muscle compartments, discoloration, and cooling of the limb. Preventive measures can be taken without contaminating the surgical field by returning the limb to the right atrium level. Once the diagnosis has been made, failure to prevent the development of WLCS requires extensile fasciotomy of each leg compartment to restore perfusion and relieve elevated intra-compartment pressures. This article reviews the pathophysiology, prevention, and treatment of WLCS.
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Kajitani R, Minami M, Kubo Y, Iwaihara H, Takishita Y, Isayama M, Ohno R, Hayashi T, Sasaki T, Matsumoto Y, Nagano H, Komono A, Aisu N, Yoshimatsu G, Yoshida Y, Hasegawa S. Intraoperative pressure monitoring of the lower leg for preventing compression-related complications associated with the lithotomy position. Surg Endosc 2021; 36:5873-5881. [PMID: 34851475 DOI: 10.1007/s00464-021-08921-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several serious complications are associated with the lithotomy position, including well-leg compartment syndrome and peroneal nerve paralysis. The aims of this study were to identify risk factors for the intraoperative elevation of lower leg pressure and to evaluate the effectiveness of monitoring external pressure during surgery for preventing these complications. METHODS The study included 106 patients with a diagnosis of sigmoid colon or rectal cancer who underwent elective laparoscopic surgery between June 2019 and December 2020. We divided the posterior side of the lower leg into four parts (upper outside, upper inside, lower outside, lower inside) and recorded the peak pressure applied to each area at hourly intervals during surgery (called "regular points") and when the operating position was changed (e.g., by head-tilt or leg elevation; called "points after change in position"). When the pressure was observed to be higher than 50 mmHg, we adjusted the position of the leg and re-recorded the data. Data on postoperative leg-associated complications were also collected. RESULTS The pressure was measured at a total of 1125 points (regular, n = 620; after change of position, n = 505). The external pressure on the upper outer side of the right leg (median, 36 mmHg) was higher than that on any other area of the lower leg. The pressure increase to more than 50 mmHg was observed not only during the change of position (27.5%) but also during regular points (22.4%). Bodyweight, strong leg elevation, and low head position were identified as factors associated with increased external pressure. There have been no compression-related complications in 534 cases at our institution since the introduction of intraoperative pressure monitoring. CONCLUSIONS Several risk factors associated with increased external pressure on the lower leg were identified. Intraoperative pressure monitoring might help reduction of pressure-related complications, needing further and larger prospective data collections.
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Affiliation(s)
- Ryuji Kajitani
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Maiko Minami
- Department of Operative Service, Fukuoka University Hospital, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, Japan
| | - Yuka Kubo
- Department of Operative Service, Fukuoka University Hospital, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, Japan
| | - Haruka Iwaihara
- Department of Operative Service, Fukuoka University Hospital, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, Japan
| | - Yurie Takishita
- Department of Operative Service, Fukuoka University Hospital, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, Japan
| | - Mie Isayama
- Department of Operative Service, Fukuoka University Hospital, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, Japan
| | - Ryo Ohno
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Takaomi Hayashi
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Takahide Sasaki
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Hideki Nagano
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Akira Komono
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Yoichiro Yoshida
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1, Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan.
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Jardaly A, Conklin MJ, Gilbert SR. Leg Compartment Syndrome Complicating Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Case Report. Am J Case Rep 2021; 22:e927082. [PMID: 33637670 PMCID: PMC7930511 DOI: 10.12659/ajcr.927082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Male, 15-year-old Final Diagnosis: Compartment syndrome Symptoms: Pain Medication: — Clinical Procedure: — Specialty: Orthopedics and Traumatology
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Affiliation(s)
- Achraf Jardaly
- Department of Orthopedics, Lebanese American University, Gilbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon.,Department of Orthopedics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Conklin
- Department of Orthopedics, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Pediatric Orthopedics, Children's Hospital of Alabama, Birmingham, AL, USA
| | - Shawn R Gilbert
- Department of Orthopedics, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Pediatric Orthopedics, Children's Hospital of Alabama, Birmingham, AL, USA
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Laso-García IM, Arias-Fúnez F, Duque-Ruiz G, Díaz-Pérez D, Lorca-Álvaro J, Burgos-Revilla FJ. Well-Leg Compartment Syndrome After Percutaneous Nephrolithotomy in the Galdakao-Modified Supine Valdivia Position. Res Rep Urol 2020; 12:295-302. [PMID: 32802806 PMCID: PMC7386809 DOI: 10.2147/rru.s259357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose The objective is to present a case of well-leg compartment syndrome in the Galdakao-modified supine Valdivia position. Results The case of a 32-year-old male, obese (105 Kg) and a former smoker is presented. The patient was positioned in the Galdakao-modified supine Valdivia position, with lower limbs bandaged, to perform a right percutaneous nephrolithotomy. In the immediate postoperative period, significant pain was reported in the left lower limb. The limb appeared oedematous and cyanotic, although pedis pulses were preserved. Doppler ultrasound ruled out venous thrombosis. Suspecting compartment syndrome, the patient underwent a complete decompression fasciotomy of the four left leg compartments. After the surgery, values of creatine phosphokinase reached 80.000 UI/L and serum creatinine levels were 1.53 mg/dL. The patient was taken to the intensive care unit. Six months after the episode, the patient still needs rehabilitation care. The compartment syndrome is a rare complication in lithotomy position, but never described in the Galdakao-modified supine Valdivia position before, with the lower limbs in moderate flexion, and with the ipsilateral lower limb in a slightly inferior position with respect to the other. It may lead to skin necrosis, permanent neuromuscular dysfunction, myoglobinuric renal failure, amputation and even death. Therefore, this complication must be suspected and early decompression of the compartment must be performed. Risk factors include obesity, peripheral vascular disease (advanced age, hypertension, hyperlipidemia and diabetes mellitus), height, hypothermia, acidemia, BMI, male sex, combined general-spinal anesthesia, prolonged surgery time, systemic hypotension, ASA (American Society of Anesthesiologists) class, lack of operative experience, vasoconstricting drugs, important bleeding during the surgery and increased muscle bulk. Conclusion Compartment syndrome is a potentially life-threatening complication that may occur in the Galdakao-modified supine Valdivia position. It should be suspected in cases with risk factors and compatible clinical symptoms and signs, and treated rapidly to avoid further complications.
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Affiliation(s)
- Inés María Laso-García
- Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain
| | - Fernando Arias-Fúnez
- Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain
| | - Gema Duque-Ruiz
- Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain
| | - David Díaz-Pérez
- Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain
| | - Javier Lorca-Álvaro
- Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain
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Brouze IF, Steinmetz S, McManus J, Borens O. Well leg compartment syndrome in trauma surgery - femoral shaft fracture treated by femoral intramedullary nailing in the hemilithotomy position: case series and review of the literature. Ther Clin Risk Manag 2019; 15:241-250. [PMID: 30799923 PMCID: PMC6371926 DOI: 10.2147/tcrm.s177530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Well leg compartment syndrome (WLCS) is a rare complication which can occur following urological, gynecological, general surgical or orthopedic surgeries carried out with the lower limb in the hemilithotomy position. WLCS is associated with significant morbidity and mortality because delay in diagnosis and treatment can lead to loss of function and even life-threatening complications. During orthopedic surgeries on a traction table, such as femoral nailing, the contralateral “well leg” is often placed in the hemilithotomy position, thus facilitating the use of fluoroscopy. This position (also named the Lloyd-Davis position) consists of hip flexion, abduction, external rotation and knee flexion. We present the cases of two teenaged patients who underwent femoral nailing on an extension table of a femoral fracture and developed WLCS. We also present a review of the literature and a discussion of the pathophysiology, risk factors and treatment of this condition. Clinicians need to be aware of the risk factors for WLCS and have high index of suspicion. Further studies looking at the risks, benefits and feasibility of ways to reduce this risk are required.
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Affiliation(s)
- Iris F Brouze
- Orthopedics and Traumatology Service, CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,
| | - Sylvain Steinmetz
- Orthopedics and Traumatology Service, CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,
| | - John McManus
- Orthopedics and Traumatology Service, CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,
| | - Olivier Borens
- Orthopedics and Traumatology Service, CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,
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Chen IW, Sun CK, Chen JY, Lin CM, Hung KC. Nonfatal pulmonary embolism associated with the use of compression stockings in the lithotomy position after spinal anesthesia. Tzu Chi Med J 2018; 29:228-231. [PMID: 29296053 PMCID: PMC5740697 DOI: 10.4103/tcmj.tcmj_81_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 73-year-old male (height, 156 cm; body weight, 51 kg), without a history of cardiovascular disease or thromboembolic events, was scheduled for transurethral resection of the prostate under spinal anesthesia. Spinal anesthesia was administered with hyperbaric bupivacaine, resulting in an upper anesthetic level of T6. Before surgery, compression stockings were applied to both lower limbs, and the patient was placed in the lithotomy position. Approximately 15 min later, he complained of intolerable chest tightness, followed by tachycardia (heart rate, 110 beats/min) and desaturation (oxygen saturation [SaO2], 90%). Tracheal intubation was performed immediately. The decrease in end-tidal partial pressure of carbon dioxide (EtCO2) with an increase in the arterial carbon dioxide partial pressure-EtCO2 gradient (16 mmHg) suggested pulmonary embolism (PE), which may have been induced by leg manipulation. The patient developed transient hypotension after tracheal intubation; however, his hemodynamic profile stabilized after inotropes administration. Subsequent tests showed normal cardiac enzyme levels; however, his D-dimer levels increased significantly. Imaging confirmed deep vein thrombosis (DVT) and PE. Anticoagulation with warfarin was administered, and he was discharged on the postoperative day 11 without complications. In conclusion, DVT is often a cause of PE. Preoperative identification of DVT risk factors and respiratory symptoms as well as intraoperative monitoring of arterial SaO2 are vital for timely diagnosis of PE, especially in patients receiving intraoperative lower limb manipulation.
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Affiliation(s)
- I-Wen Chen
- Department of Anesthesiology, E-Da Hospital, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.,Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chien-Ming Lin
- Department of Anesthesiology, E-Da Hospital, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
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Cahn J, Van Wicklin SA. Clinical Issues-January 2018. AORN J 2018; 107:132-141. [DOI: 10.1002/aorn.12009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mizuno J, Takahashi T. Evaluation of external pressure to the sacral region in the lithotomy position using the noninvasive pressure distribution measurement system. Ther Clin Risk Manag 2017; 13:207-213. [PMID: 28255240 PMCID: PMC5322810 DOI: 10.2147/tcrm.s122489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pressure ulcers (PUs) in the sacral region can be a complication of surgical procedures performed in the lithotomy position. Previous reports have noted a difference between men and women in PU development related to the supine position, and body weight and body mass index (BMI) have been also described as known risk factors in supine position-related PU development. The BIG-MAT® system is a noninvasive pressure distribution measurement device used to measure external pressure (EP). We used this system to investigate the relationship between EP to the sacral region in the lithotomy position and selected physical characteristics. METHODS We recruited 21 young, healthy volunteers (11 men and 10 women, aged 21.4±0.5 years). Using the BIG-MAT system, we measured four types of EP to the sacral region: box pressure, peak box pressure, contact pressure, and peak contact pressure. We analyzed the relationships between these dynamic parameters and physical characteristics of the participants. RESULTS There were no differences between men and women in the four types of EP, and no significant differences related to the participants' height, weight, or BMI. CONCLUSION An individual's height, weight, and BMI may not contribute to the risk of inducing lithotomy position-related PUs in the sacral region. The noninvasive pressure distribution measurement system BIG-MAT for patients in the lithotomy position during surgery could become a significant device when estimating EP at the sacral region.
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Affiliation(s)
- Ju Mizuno
- Department of Anesthesiology and Pain Medicine, Juntendo University, Faculty of Medicine, Bunkyo-ku, Tokyo
| | - Toru Takahashi
- Faculty of Health and Welfare Science, Okayama Prefectural University, Soja-shi, Okayama, Japan
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Enomoto T, Ohara Y, Yamamoto M, Oda T, Ohkohchi N. Well leg compartment syndrome after surgery for ulcerative colitis in the lithotomy position: A case report. Int J Surg Case Rep 2016; 23:25-8. [PMID: 27085103 PMCID: PMC4855417 DOI: 10.1016/j.ijscr.2016.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Well leg compartment syndrome (WLCS) is an uncommon and severe complication that occurs after colorectal surgery in the lithotomy position. PRESENTATION OF CASE The current patient was a 28-year-old male suffering from ulcerative colitis. He was underwent elective proctectomy, including ileal J pouch formation and anal anastomosis with temporary loop ileostomy. The ileoanal pouch procedure was quite difficult, and during this procedure, the high lithotomy and head down tilt positions were continued for 255min. After the operation, the patient complained of severe cramping pain, swelling and serious tenderness on palpation in both legs. On the first postoperative day, the patient's complaints gradually worsened. The intra-compartmental pressure was measured, and WLCS was diagnosed. Emergency bilateral fasciotomy was performed. Initially, the patient had a sensory deficit and analgesia, however, his sensory disturbance and pain had almost recovered two months after fasciotomy by rehabilitation. DISCUSSION In the current case, the important factors associated with the development of WLCS are thought to be a prolonged operative time in which the patient is placed in the high lithotomy position during ileoanal pouch procedure. CONCLUSION We would thus like to emphasize that operations for the ileoanal pouch procedure to treat ulcerative colitis have a high potential for inducing WLCS, because it usually requires a prolonged operative time in which the patient remains in the high lithotomy position.
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Affiliation(s)
- Tsuyoshi Enomoto
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Yusuke Ohara
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Masayoshi Yamamoto
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba-shi, Ibaraki-ken 305-8558, Japan.
| | - Tatsuya Oda
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
| | - Nobuhiro Ohkohchi
- University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan.
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