Abstract
PURPOSE: Lower limb compartment syndrome has been reported to occur after colorectal, urological, and gynecological procedures during which the patient's lower limbs are elevated for prolonged periods of time. METHOD: We investigated lower limb perfusion in a group of patients undergoing prolonged pelvic surgery both during and immediately after surgery, using intra-arterial blood pressure monitoring, laser doppler flowmetry, and pulse oximetry. RESULTS: Use of the modified lithotomy position was not associated with any demonstrable decrease in lower limb perfusion. The addition of 15° head-down tilt, however, during pelvic dissection, led to an immediate and significant drop in lower limb perfusion (P<0.05; Mann-WhitneyU test). The subgroup of patients analyzed postoperatively showed a ten-fold increase (P<0.01) in perfusion that was confined to the muscle compartment with no demonstrable increase in skin perfusion or intra-arterial pedal blood pressure. CONCLUSION: The use of the modified lithotomy position during pelvic surgery is not associated with lower limb ischemia. Addition of Trendelenburg position, however, causes profound ischemia of the lower limbs, and this is followed during the recovery period by hyperperfusion that is confined to the muscle compartments, which may put patients at risk of developing lower limb compartment syndrome.
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References
Peters P, Baker SR, Leopold PW, Taub NA, Burnand KG. Compartment syndrome following prolonged pelvic surgery. Br J Surg 1994;81:1128–31.
Mubarek SJ, Hargens AR. Acute compartment syndromes. Surg Clin North Am 1983;63:539–65.
Patman RD. Compartmental syndromes in peripheral vascular surgery. Clin Orthop 1975;113:103–10.
Perler BA, Tohmeh AG, Bulkley GB. Inhibition of the compartment syndrome by the ablation of the free radical-mediated reperfusion injury. Surgery 1990;108:40–7.
Finkelstein JA, Hunter GA, Hu RW. Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma 1996;40:342–4.
Rorabeck CH, Clarke KM. The pathophysiology of anterior tibial compartment syndrome: an experimental investigation. J Trauma 1978;18:299–304.
Neagle CE, Schaffer JL, Heppenstall RB. Compartment syndrome complicating prolonged use of the lithotomy position. Surgery 1991;110:566–9.
Friedman JJ.86Rb extraction as an indicator of capillary flow. Circ Res 1971;28/29:15–20.
Gidloff A, Hammerson F, Larsson J, Lewis DH, Liljedahl SO. Is capillary endothelium in human skeletal muscle an ischaemic shock tissue? In: DH Lewis, ed. Induced skeletal muscle ischaemia in man. Basel: Karger, 1982:63–79.
Strock PE, Majno GM. Vascular responses to experimental tourniquet ischaemia. Surg Gynecol Obstet 1969;129:309–18.
Bergqvist D, Bohe M, Ekelund G,et al. Compartment syndrome after prolonged surgery with leg supports. Int J Colorect Dis 1990;5:1–5
MacIntosh EL, Blanchard RJ. Compartment syndrome after surgery in the lithotomy position. Can J Surg 1991;34:359–62.
Reddy PK, Kaye KW. Deep posterior compartmental syndrome: a serious complication of the lithotomy position. J Urol 1984;132:144–5.
Strecker WB, Spielman FJ. Compartment syndrome masked by epidural anesthesia for postoperative pain. Report of a case. J Bone Joint Surg 1986;68:1447–8.
Montgomery CJ, Ready LB. Epidural opioid analgesia does not obscure diagnosis of compartment syndrome resulting from prolonged lithotomy position. Anaesthesiology 1991;75:541–3.
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Presented at The Association of Surgeons of Great Britain and Ireland, Edinburgh, United Kingdom, May 13 to 15, 1998.
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Horgan, A.F., Geddes, S. & Finlay, I.G. Lloyd-davies position with trendelenburg—A disaster waiting to happen?. Dis Colon Rectum 42, 916–919 (1999). https://doi.org/10.1007/BF02237102
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DOI: https://doi.org/10.1007/BF02237102