Compartment syndrome of the leg associated with lithotomy position for cytoreductive surgery

Abstract

Compartment syndrome is seen in patients who have ischemic damage to muscle that is contained within a fascial compartment. A pathologic cycle is initiated when tissue injury produces swelling and compromises muscle perfusion. Patients undergoing cytoreductive surgery combined with intraperitoneal chemotherapy are required to be in the lithotomy position for many hours. Compartment syndrome can develop necessitating fasciotomy. In a study of 473 operative procedures to perform cytoreductive surgery and intraperitoneal chemotherapy, eight patients required fasciotomy on an emergency basis to treat compartment syndrome and were recorded in a prospective database over a 4-year time period. During the hospitalization five of the eight patients developed venous thrombotic complications. In order to prevent movement of the patient on the operating table during steep Trendelenburg position, shoulder braces were used in the subsequent 250 patients and no episodes of compartment syndrome occurred. Compartment syndrome in patients undergoing cytoreductive surgery may be related to changes in position on the operating table induced by steep Trendelenburg position. Minimizing this change in position has reduced the likelihood of developing Compartment syndrome.