Compartment syndrome after prolonged surgery with leg supports

Area of Science:

• Surgical complications
• Orthopedic surgery
• Patient positioning

Background:

• Compartment syndrome is a rare but serious complication that can occur after prolonged surgical procedures, particularly when patients are positioned in leg supports.
• This study investigates compartment syndrome in patients undergoing cystourethrectomy with pelvic pouch and ileoanal anastomosis, a position that involves prolonged leg support.

Observation:

• A review of 11 patients who underwent pelvic pouch and ileoanal anastomosis revealed a median duration of 6.4 hours in the leg support position.
• Four patients developed leg pain and swelling within 12 hours of surgery.
• Compartment pressure measurements in one patient showed intermittent pressures up to 50 mm Hg, with decreased pressure upon knee bending.

Findings:

• The study analyzed one recent case and six from the literature, alongside 11 patients from the department, to understand the incidence and characteristics of compartment syndrome in this surgical context.
• Leg pain and swelling were observed in 4 out of 11 patients after prolonged leg support during surgery.
• Compartment pressure monitoring indicated elevated pressures, which were responsive to changes in leg position.

Implications:

• These findings highlight the risk of compartment syndrome associated with prolonged leg support during specific surgical procedures.
• Early recognition and monitoring of leg pain and swelling are crucial for timely diagnosis and intervention.
• Adjusting patient positioning, such as knee bending, may help alleviate elevated compartment pressures and potentially prevent or manage compartment syndrome.