Avoiding, diagnosing and treating well leg compartment syndrome after pelvic surgery

Abstract

Background Patients undergoing prolonged pelvic surgery may develop compartment syndrome of one or both lower limbs in the absence of direct trauma or pre‐existing vascular disease (well leg compartment syndrome). This condition may have devastating consequences for postoperative recovery, including loss of life or limb, and irreversible disability. Methods These guidelines represent the collaboration of a multidisciplinary group of colorectal, vascular and orthopaedic surgeons, acting on behalf of their specialty associations in the UK and Ireland. A systematic analysis of the available peer‐reviewed literature was undertaken to provide an evidence base from which these guidelines were developed. Results These guidelines encompass the risk factors (both patient‐ and procedure‐related), diagnosis and management of the condition. Key recommendations for the adoption of perioperative strategies to facilitate prevention and effective treatment of well leg compartment syndrome are presented. Conclusion All surgeons who carry out abdominopelvic surgical procedures should be aware of well leg compartment syndrome, and instigate policies within their own institution to reduce the risk of this potentially life‐changing complication.

Well Leg Compartment Syndrome after Contralateral Femoral Neck ORIF

“…BMI, age, and gender have been identified as risk factors that must be considered perioperatively. BMI ≥ 25 has been associated with increased risk of WLCS due to a decrease in ankle blood pressure and increased intramuscular pressure when in the hemilithotomy position [2]. Younger, male patients are also at increased risk, potentially due to increased muscle mass and overall stronger fascia which can maintain elevated compartmental pressures [9].…”

“…Well leg compartment syndrome (WLCS) is a serious surgical complication that has been documented in a variety of surgical procedures [1]. WLCS is defined as an acute lower limb compartment syndrome developing without trauma or preexisting vascular disease (BJS guidelines) [2]. It is associated with prolonged operative positioning with the hips and knees flexed, especially in the Trendelenburg position [2].…”

“…WLCS is defined as an acute lower limb compartment syndrome developing without trauma or preexisting vascular disease (BJS guidelines) [2]. It is associated with prolonged operative positioning with the hips and knees flexed, especially in the Trendelenburg position [2]. WLCS incidence is estimated to be 1/3500 surgeries utilizing a well leg holder; however, there is speculation that it is underdocumented due to a range of symptom severity and misdiagnosis as a deep vein thrombosis [3].…”

“…WLCS presents as leg pain that cannot be addressed with pain medications and is usually noticed by the patient within the first 24 hours after surgery. Pain on passive movement at the ankle joint and elevated creatinine kinase levels support a diagnosis of WLCS [2]. In order to prevent further muscle damage, emergent fasciotomies to decompress the affected compartments are essential.…”

<p>Well-Leg Compartment Syndrome After Percutaneous Nephrolithotomy in the Galdakao-Modified Supine Valdivia Position</p>

“…It has been described that lithotomy position, in general surgical, urological and orthopaedic patients, is associated with changes in intracompartmental pressure that may eventually develop a compartment syndrome, especially in prolonged surgeries. [3][4][5][6] A significant decrease in deep muscle mixed tissue oxygen saturation of calf muscles has been observed, due to the combined effect of perfusion-related factors, such as hydrostatic forces, blood and intraabdominal pressure, which lead to tissue underperfusion. 7,8 However, this type of compartment syndrome is not part of the common complications of percutaneous nephrolithotomy (PCNL).…”