Lower leg blood pressure decreases while calf external pressure increases with the angulation of the Trendelenburg position in the lithotomy position with calf- and foot-supported leg holders

Abstract

Objective Patients who underwent lower abdominopelvic surgeries in the lithotomy position (LP) and the Trendelenburg position (TP) with the leg holder are at risk of developing well leg compartment syndrome (WLCS). However, contributing factors related to the LP with TP associated with WLCS are unknown. This study aimed to investigate the associations between external pressure at the calf in the LPs at different angulations of the TP and physiological characteristics. Methods Eighty-four university students (age, 21.7 ± 0.9; 42 men and 42 women) voluntarily participated in the study. The awake participants were placed in the LPs using the calf- and foot-supported leg holder at 0° (horizontal level), 5°, 10°, and 20° head-down tilts by moving the electric operating table. The peak contact pressure (pCP) was measured at the calf as a representative external pressure using the pressure distribution measurement system BIG-MAT®. Results Lower leg blood pressure significantly decreased with TP angulation, while calf pCP significantly increased with it at 0°, 5°, 10°, and 20° head-down tilts (39.4 ± 15.2, 46.5 ± 17.7, 47.2 ± 16.9, and 50.3 ± 17.6 mmHg, respectively). The calf pCP with a 10° head-down tilt was correlated positively with the calf total force (P < 0.001) and negatively with the calf contact area (P < 0.001). Conclusion Blood hypoperfusion due to low lower leg blood pressure secondary to lower leg elevation and head-down tilt, and high calf external pressure due to direct external compression from the leg holder where it is loaded may contribute to WLCS.

Upper extremity contact pressure measurement in robot-assisted pelvic surgery

“…In the present study, shoulder pain was observed in 3.5 % of all cases and is considered a relatively common complication; high UEP in the LT position may be a useful marker to predict complications of the upper extremity in RAPS. With regards to the contact pressure in the lower extremity, reports including previous literature de ne the safe range of the contact pressure as less than 32 mmHg based on capillary pressure [11][12]. However, the present study showed that the median contact pressure of patients associated with shoulder pain was 25.6 mmHg (15.…”

“…The contact pressure is calculated as P = F / A (P: pressure, F: force, A: area) [12]. In the Trendelenburg position, body uid moves from the legs toward the heart by gravitational displacement due to body inversion [13].…”