Prevention of well-leg compartment syndrome following lengthy medical operations in the lithotomy position

Hara, Kazuyoshi; Kuroki, Tamotsu; Kaneko, Shohei; Taniguchi, Koichi; Fukuda, Masashi; Onita, Toru; Sawai, Terumitsu

doi:10.1016/j.sopen.2020.10.001

Cited by 18 publications

(17 citation statements)

References 30 publications

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“…Among our WLCS prevention measures, one of the interventions is performing a horizontal return every 3 hours to improve blood flow to the lower extremities. [ 9 ] Although there was a decreasing trend in the lower limb PI, there was no significant difference in the PI when patients were returned to the horizontal position from the Trendelenburg position. However, a change in the lower leg pressure should be noted.…”

Section: Discussionmentioning

confidence: 99%

“…Five interventions completely prevented the incidence of WLCS, including a-2) intraoperative decompression of the lower leg contact site by the surgeon and b-4) returning the patient to the horizontal position every 3 hours by Trendelenburg position. [ 9 ] No occurrence of WLCS has been reported at our operation center since these measures were implemented. However, the lack of supporting evidence, such as changes in blood perfusion due to interventions, remains an issue for further investigation.…”

Section: Introductionmentioning

confidence: 99%

“…[8] At our surgical center, WLCS has been reported in 0.83% of cases. [9] Therefore, we consulted operating room nurses, general surgeons, obstetricians, and urologists and developed the following recommendations for procedures that can be modified to the open leg position: a-1) change from the lithotomy position to the open leg position; b-1) base lower limb elevation restriction on the right atrium height; b-2) prevention of compression at the lower leg contact site; and b-3) provision of nursing care. Five interventions completely prevented the incidence of WLCS, including a-2) intraoperative decompression of the lower leg contact site by the surgeon and b-4) returning the patient to the horizontal position every 3 hours by Trendelenburg position.…”

Section: Introductionmentioning

confidence: 99%

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Effect of intraoperative operating table rotation on lower limb perfusion index in patients in the lithotomy position

et al. 2022

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We focused on "returning to the horizontal position," one of the measures for preventing well leg compartment syndrome implemented at our hospital, and aimed to clarify the effect of intraoperative positional changes by operating table rotation on blood perfusion in the lower extremities during lithotomy in patients under general anesthesia. This prospective observational study examined 64 patients scheduled to undergo general anesthesia in the lithotomy position from March 2021 to May 2022. The primary endpoint was the perfusion index (PI) of the lower limb before and after operating table rotation. The baseline lower limb PI before the operating table rotation was 2.376 (1.591), and the lower limb PI after the change from Trendelenburg to the horizontal position was as follows: immediately after, 2.123 (1.405); 5 minutes, 1.894 (1.138); 10 minutes, 1.915 (1.167); and 15 minutes, 1.993 (1.218). Compared with the baseline, no significant difference was noted in the change in the lower limb PI due to the Trendelenburg to horizontal positional change. The baseline lower leg pressure before the operating table rotation was 51.4 (13.4) mm Hg, and the lower leg pressure after the change from the Trendelenburg to the horizontal position was as follows: immediately after, 36.6 (10.3) mm Hg; 5 minutes, 36.5 (10.2) mm Hg; 10 minutes, 36.4 (10.0) mm Hg; and 15 minutes, 36.5 (10.2) mm Hg. Compared with the baseline, the change in lower leg pressure due to the Trendelenburg to horizontal positional change showed a significant decrease immediately afterward (P < .001). After operating table rotation from the Trendelenburg to the horizontal position, the lower limb PI did not change significantly after 15 min. However, lower leg pressure showed a significant decrease immediately after returning to the horizontal position. This result provides evidence for operating table rotation as a preventive measure for well leg compartment syndrome.Abbreviations: BP = blood pressure, PI = perfusion index, WLCS = well leg compartment syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of intraoperative operating table rotation on lower limb perfusion index in patients in the lithotomy position

et al. 2022

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“…Several interventions to prevent DTI during surgery have been reported to reduce its occurrence. 19 . In that study, surgery was performed in the open leg position with minimal or no elevation of the lower extremities, if technically feasible, with the patient's body leveled every 3 hours.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the postoperative risk of deep tissue injury to the lower extremities following surgery in the lithotomy position

Yukizawa

Kobayashi

Kamono

et al. 2022

Preprint

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The aim of this study was to determine the incidence of deep tissue injury (DTI) and its potential risk factors after surgery in the lithotomy position. MethodsAll patients who underwent surgery in the lithotomy position under general anesthesia at a single center between January 2015 and December 2019 were retrospectively evaluated. The medical records of these patients were reviewed, and patient demographic and clinical characteristics, surgical data, and occurrence of DTI were recorded. ResultsDuring the study period, 5146 patients, 2055 (39.9%) males and 3091 (60.1%) females, of mean age 57.3 ± 17.4 years, underwent surgery in the lithotomy position. Seven (0.14%) patients developed DTI on their calf following surgery. All presented with severe pain and swelling, requiring prolonged hospital stay.

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“…Horizontally repositioning the operating table every 3 h to maintain blood flow to the leg; and 6. Decompressing the contact area of the leg when the patient is in the lithotomy position during surgery [ 26 ].…”

Section: Preventing Development Of Wlcsmentioning

confidence: 99%

Well Leg Compartment Syndrome: Pathophysiology, Prevention, and Treatment

Nester

Borrelli

2022

JCM

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The development of compartment syndrome involving the lower limb is a potentially devastating complication of prolonged surgery in patients held in the lithotomy position. Well leg compartment syndrome (WLCS) was recognized in 1953. The incidence of this condition has been reported to range from 0.20% to 0.03%. The mechanism of WLCS development in the absence of trauma appears to be related to prolonged hypoperfusion of the limb, pressure on the muscle compartments, and in some cases, reperfusion of the ischemic limb. This grave complication develops either during or immediately after prolonged surgery in which the patient was held in the Lloyd-Davies lithotomy or hemi-lithotomy position. Surgeons must be aware of the potential for WLCS development during prolonged surgery. Signs of developing WLCS include swelling, increased firmness of the muscle compartments, discoloration, and cooling of the limb. Preventive measures can be taken without contaminating the surgical field by returning the limb to the right atrium level. Once the diagnosis has been made, failure to prevent the development of WLCS requires extensile fasciotomy of each leg compartment to restore perfusion and relieve elevated intra-compartment pressures. This article reviews the pathophysiology, prevention, and treatment of WLCS.

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Prevention of well-leg compartment syndrome following lengthy medical operations in the lithotomy position

Cited by 18 publications

References 30 publications

Effect of intraoperative operating table rotation on lower limb perfusion index in patients in the lithotomy position

Effect of intraoperative operating table rotation on lower limb perfusion index in patients in the lithotomy position

Evaluation of the postoperative risk of deep tissue injury to the lower extremities following surgery in the lithotomy position

Well Leg Compartment Syndrome: Pathophysiology, Prevention, and Treatment

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