Well-limb compartment syndrome after prolonged lateral decubitus positioning. A report of two cases.

Abstract

External compression of a limb caused by casting, the use of military antishock trousers, or prolonged positioning secondary to drug overdose or during surgery may cause compartment syndrome in an otherwise healthy limb1. Well-leg compartment syndrome secondary to surgical positioning has been overwhelmingly associated with the lithotomy or hemilithotomy position2. A search of the literature revealed that there have been at least twenty-six cases of well-leg compartment syndrome associated with these positions, all of which occurred after at least two hours of operative time and most of which occurred after four and one-half hours2-8. In contrast to the lithotomy position, the lateral decubitus position has been reported to be associated with myonecrosis and sciatic nerve palsy but not compartment syndrome9-11. The leg represents one of the most common locations for acute compartment syndrome, whereas the thigh is a relatively rare location12. We report two cases of compartment syndrome that were associated with prolonged intraoperative lateral decubitus positioning, one of which involved the leg and one of which involved the thigh. To the best of our knowledge, these are the first two such cases that have been reported in the literature. Our patients were informed that data concerning these cases would be submitted for publication. Case 1. A fifty-eight-year-old left-hand-dominant man (approximate height, 175 cm; weight, 107 kg) underwent excisional biopsy of a 3-cm × 2-cm mobile, firm lump on the medial aspect of the left elbow at another institution, the results of which revealed a high-grade malignant fibrous histiocytoma with positive margins. Staging studies done at that institution showed no evidence of metastatic disease, and the patient was referred to our institution for further treatment. Physical examination of the patient revealed a 4-cm transverse incision …