Male sex, height, weight, and body mass index can increase external pressure to calf region using knee-crutch-type leg holder system in lithotomy position

Abstract

BackgroundWell-leg compartment syndrome (WLCS) is one of the catastrophic complications related to prolonged surgical procedures performed in the lithotomy position, using a knee-crutch-type leg holder (KCLH) system, to support the popliteal fossae and calf regions. Obesity has been implicated as a risk factor in the lithotomy position-related WLCS during surgery. In the present study, we investigated the relationship between the external pressure (EP) applied to the calf region using a KCLH system in the lithotomy position and selected physical characteristics.MethodsTwenty-one young, healthy volunteers (21.4±0.5 years of age, eleven males and ten females) participated in this study. The KCLH system used was Knee Crutch®. We assessed four types of EPs applied to the calf region: box pressure, peak box pressure, contact pressure, and peak contact pressure, using pressure-distribution measurement system (BIG-MAT®). Relationships between these four EPs to the calf regions of both lower legs and a series of physical characteristics (sex, height, weight, and body mass index [BMI]) were analyzed.ResultsAll four EPs applied to the bilateral calf regions were higher in males than in females. For all subjects, significant positive correlations were observed between all four EPs and height, weight, and BMI.ConclusionEP applied to the calf region is higher in males than in females when the subject is supported by a KCLH system in the lithotomy position. In addition, EP increases with the increase in height, weight, and BMI. Therefore, male sex, height, weight, and BMI may contribute to the risk of inducing WLCS.

Nonfatal pulmonary embolism associated with the use of compression stockings in the lithotomy position after spinal anesthesia

“…This is supported by the results of impedance plethysmography that indirectly indicated the preoperative presence of venous thrombosis. The calf support used in lithotomy position may also have exerted external compression on the lower leg, [ 11 ] thereby further increasing the chance of embolus dislodgment. In contrast to sudden cardiovascular collapse following massive PE, pleuritic chest pain may not occur immediately after the pulmonary arterial bed is occluded by smaller emboli, which may have been the reason that these signs occurred 15 min after leg manipulations.…”

Well leg compartment syndrome after surgery for ulcerative colitis in the lithotomy position: A case report

“…Two pressures are considered to affect an elevation in the intra-compartmental pressure: these are the external pressure and perfusion pressure [6] . When the external pressure compresses the skin and feeding vessels in the calf regions, then the blood flow in the peripheral vessels stops and the adjacent muscles and nerves thus become exposed to ischemia.…”

“…The external pressure is defined by the muscular status of the lower limbs, leg-holding types, the use of intermittent pneumatic calf compressors and circumferential wrappings. The hypoperfusion pressure reduces the blood flow, which thereby prevents nutrient and oxygen supply to the muscle cells [6] . The perfusion pressure is defined by prolonged surgery in the lithotomy position and the Trendelenburg position, ankle dorsiflexion, intraoperative hypotension, hypovolemia, hypothermia, vasoconstrictive drugs, epidural anesthesia, peripheral vascular disease and surgical retraction of major vessels intraoperatively [4] .…”

Clinical Issues—January 2018

“…Knee‐crutch leg holders support the weight of the patient's leg, but may not redistribute pressure, potentially increasing pressure on the popliteal space and injuring the posterior and common peroneal nerves and the popliteal artery (Figure ) . The increased pressure associated with knee‐crutch leg holders can obstruct or slow venous and lymphatic return, increase the risk for hypoperfusion in the lower extremities, and raise intracompartmental pressures …”