Acute Compartment Syndrome of the Lower Leg as an Interdisciplinary Complication after Long Duration Intervention in the Lithotomy Position

作者：Szalay G^*; Meyer C; Alt V; Heiss C; Schnettler R; Hackethal A

来源：Zentralblatt fur Chirurgie, 2010, 135(2): 163-167.

DOI：10.1055/s-0029-1224706

• compartment syndrome
• dermatofasciotomy
• lithotomy position
• well-leg syndrome

Introduction: The positioning-related compartment syndrome of the lower leg after long-duration operations in the lithotomy position represents a rare complication. The aim of this retrospective study was to draft recommendations to avoid this rare complication by reviewing the cases with positioning-related compartment syndromes in our own patient data.
Patients/Material and Methods: From January 1996 to February 2009, 3 women and 1 man with an average age of 38 years (24 to 55 years) were treated with a medial and lateral dermatofasciotomy with opening of lower leg loges due to a clinically manifested compartment syndrome of the lower leg after long-duration operations in the lithotomy position.
Results: In all 4 patients a dermatofasciotomy with opening of the lower leg compartments could avoid considerable secondary damage of the limb. A long-duration lithotomy position in connection with obesity, a low positioning of the head as well as nicotine abuse are only some of the risk factors contributing to the development of a positioning-related compartment syndrome. An epidural anaesthesia bears the risk of a protracted diagnosis.
Conclusion: The positioning-related compartment syndrome represents a rare but considerable complication after long-duration operations in the lithotomy position. It is a clinical complication and the inducing and exponentiation risk factors as well as the clinical symptoms should be known by the treating team. If the operation time is expected to be longer than 3 hours, we recommend written information to the patient concerning this complication. Consequent postoperative controls of risk patients are obligatory. An epidural anaesthesia bears the risk of a protracted diagnosis. In the case of suspected compartment syndrome we recommend early dermatofasciotomy in order to avoid irreversible damage to the limb.

• 出版日期2010-4