Lower limb compartment syndrome associated with the lithotomy position: concepts and perspectives for the urologist

Abstract

SummaryLower limb compartment syndrome after a prolonged period in the lithotomy position develops as a result of an increase in the pressure within a closed muscle compartment that impedes arterial perfusion. It is associated with several diverse circumstances and risk factors. The resultant ischaemia may have permanent and disabling sequelae. It is therefore essential that the risk factors are promptly recognized and appropriate action taken to prevent the disastrous sequelae of compartment syndrome. Immediate decompression could be effective in preventing the limb dysfunction that results from an untreated compartment syndrome.

Well‐leg compartment syndrome after gynecological laparoscopic surgery

“…Fasciotomy has to be performed as soon as the diagnosis is made . The current general consensus for initiating fasciotomy in order to minimize unnecessary fasciotomies and irreversible neuromuscular damage is thought to be an ICP within 20 mmHg of diastolic pressure or a substantial clinical suspicion. With the move of gynecological surgery towards longer procedures in the lithotomy position, an increase in WLCS frequency may be expected.…”

Compartment Syndrome Following Lower Limb Arthroplasty: A Review

“…This, in combination with the low index of suspicion for CS may create a disastrous combination. It is essential, when using local epidural anaesthetics that the intensity of the block is appropriate to the anticipated intensity of the wound pain without inducing motor blockade [41]. Nonetheless, analgesia should not be misunderstood as the cause but only as being a factor delaying the diagnosis.…”

“…Furthermore, it is useful in identifying which of the compartments are involved. Decompression is generally recommended when the compartment pressure exceeds 30 mmHg to 35 mmHg [8, 41, 44]. The view that fasciotomy should be generally performed when tissue pressure rises over 20 mmHg below diastolic pressure [34, 46] appears to be of wide acceptance lately.…”

“…The presence of myoglobinuria suggests an impending CS but the amount of myoglobinuria does not correlate with the degree of underlying tissue injury [51]. Prophylactic use of mannitol may obviate the need for decompressive fasciotomy [41], however if myoglobinuria is established enforced diuresis is recommended in order to avoid renal complications [50]. …”

Lower limb compartment syndrome as a complication of laparoscopic laser surgery for severe endometriosis

“…At the lower limb, for example, four compartments can be identified, each enclosed by unyielding osteofascial tissue and containing muscular, neural, and vascular structures (3,4).…”