Well-leg Compartment Syndrome Research Articles

Preliminary comparative study of lower extremity pressure measurements under the conditions using former models and new lithotomy stirrups in rectal cancer surgery

BackgroundThis study aimed to investigate the effect of the use of new lithotomy stirrups-2 on the pressure dispersal on lower limbs, which may lead to the prevention of well-leg compartment syndrome (WLCS) and deep venous thrombosis (DVT), which are the most commonly associated adverse events with laparoscopic and robot-assisted rectal surgery.MethodsA total of 30 healthy participants were included in this study. The pressure (mmHg) applied on various lower limb muscles when using conventional lithotomy stirrups-1 and new type stirrups-2 was recorded in various lithotomy positions; 1) neutral position, 2) Trendelenburg position (15°) with a 0° right inferior tilt, and 3) Trendelenburg position (15°) with a 10° right inferior tilt. Using a special sensor pad named Palm Q®, and the average values were compared between two types of stirrups.ResultsThe use of new lithotomy stirrups-2 significantly reduced the pressure applied on the lower limb muscles in various lithotomy positions compared with the use of lithotomy stirrups-1. The most pressured lower limb muscle when using both lithotomy stirrups was the central soleus muscle, which is the most common site for the development of WLCS and DVT. In addition, when using the conventional lithotomy stirrups-1, the pressure was predominantly applied to the proximal soleus muscle; however, when using lithotomy stirrups-2, the pressure was shifted to the more distal soleus muscle.ConclusionThese results suggest that the new lithotomy stirrups-2 is useful in reducing the pressure load on leg muscles, especially on the proximal to central soleus, and may reduce the incidence of WLCS and DVT after rectal surgery performed in the lithotomy position. Further clinical studies are needed to determine whether the use of lithotomy stirrups-2 prevents these complications in various clinical settings.

Bilateral Well-Leg Compartment Syndrome (WLCS) after Urological Procedure: A Case Report

Bilateral Well-Leg Compartment Syndrome (WLCS) after Urological Procedure: A Case Report

Preventing well leg compartment syndrome among patients in the lithotomy position-Operating room nurses' perspectives: A qualitative study.

To describe operating room nurses' experiences of well leg compartment syndrome and how they work perioperative to prevent it during the lithotomy position. The study had a qualitative design. Focus group interviews were performed with 10 operating room (OR) nurses. The interviews were semi-structured and analysed by qualitative content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). The main theme showed that the OR nurses shoulder duty and responsibility, independently and in the team, but they need more structural support and knowledge. The themes showed that they follow routines whenever possible and take responsibility for positioning; however, they have to balance between flexibility and strict routines. Although they also develop and participate in teamwork, they still need further knowledge. The severe complication of well leg compartment syndrome (WLCS) can occur when the patient is in the lithotomy position. Maintaining the same routines and paying attention to the WHO's surgical safety checklist were described as actions that could prevent well leg compartment syndrome. No patient or public contribution. We have interviewed nurses but without financial support since the study was performed and supervised within a master programme.

Two fasciotomies performed for well-leg compartment syndrome after robot-assisted surgery: A case report

Two fasciotomies performed for well-leg compartment syndrome after robot-assisted surgery: A case report

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.

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. 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®. 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 ± 17.6mmHg, 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). 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.

Well Leg Compartment Syndrome: Pathophysiology, Prevention, and Treatment.

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.

Analysis of external pressure on the left calf in the Lloyd-Davies position during colorectal surgery.

Well-leg compartment syndrome (WLCS) is a potentially life-threatening postoperative complication related to the Lloyd-Davies surgical position, which can place increased external pressure on the calf region. We conducted this study to analyze external pressure changes, by applying a leg holder system to the left calf region of patients placed in the Lloyd-Davies position during laparoscopic surgery. The study participants were 50 patients who underwent laparoscopic surgery for colorectal cancer in the Lloyd-Davies position. We assessed the maximum external pressure (MEP) on the left calf region using a pressure-distribution measurement system. Intraoperative measurements were taken continuously, and the MEP was evaluated with the patient horizontal and every 30min during surgery in the head and right-down tilt position. The intraoperative MEP increased gradually when the patient was in the head and right-down tilt position and decreased when the patient was returned to the horizontal position. The MEP was higher in patients aged < 60years, those who were obese, and those with a thick calf circumference. Both body mass index (BMI) and the maximum left calf circumference (MLCC) were found to correlate with the MEP. In addition to a high BMI, which is a well-known risk factor for WLCS, a high MLCC should be considered another risk factor, especially for patients under 60years.

A Case of Well Leg Compartment Syndrome After Robot-assisted Laparoscopic Prostatectomy:With Review

Robot-assisted laparoscopic prostatectomy (RALP) for prostate cancer was introduced in 2000 and rapidly gained popularity. The Da Vinci Surgical System? can ensure improved local control of cancer and fewer perioperative complications. However, RALP is performed in the steep-Trendelenburg position (a combination of lithotomy and head-down tilt position/Lloyd-Davies position) to obtain a good surgical view, and as a result, well leg compartment syndrome (WLCS) can become a serious complication of RALP. Here, we report a case of WLCS after RALP. A 75-year-old man underwent surgery for prostate cancer and immediately complained of pain and numbness after surgery. The pressure of the four leg compartments increased. Ultimately, we diagnosed the patient with WLCS in his right leg, and an emergency fasciotomy was performed. He completely recovered with no permanent disability and was discharged one month after rehabilitation. Although WLCS after RALP is a rare and severe complication, the patient recovered completely with early diagnosis and intervention. Measuring the compartment pressure is useful when the patient is drowsy immediately after recovery from anesthesia. Preventing WLCS requires identifying this condition as a potential complication of RALP and all urologic surgeries performed in the lithotomy position. J. Med. Invest. 69 : 145-147, February, 2022.

Intraoperative pressure monitoring of the lower leg for preventing compression-related complications associated with the lithotomy position.

Several serious complications are associated with the lithotomy position, including well-leg compartment syndrome and peroneal nerve paralysis. The aims of this study were to identify risk factors for the intraoperative elevation of lower leg pressure and to evaluate the effectiveness of monitoring external pressure during surgery for preventing these complications. The study included 106 patients with a diagnosis of sigmoid colon or rectal cancer who underwent elective laparoscopic surgery between June 2019 and December 2020. We divided the posterior side of the lower leg into four parts (upper outside, upper inside, lower outside, lower inside) and recorded the peak pressure applied to each area at hourly intervals during surgery (called "regular points") and when the operating position was changed (e.g., by head-tilt or leg elevation; called "points after change in position"). When the pressure was observed to be higher than 50mmHg, we adjusted the position of the leg and re-recorded the data. Data on postoperative leg-associated complications were also collected. The pressure was measured at a total of 1125 points (regular, n = 620; after change of position, n = 505). The external pressure on the upper outer side of the right leg (median, 36mmHg) was higher than that on any other area of the lower leg. The pressure increase to more than 50mmHg was observed not only during the change of position (27.5%) but also during regular points (22.4%). Bodyweight, strong leg elevation, and low head position were identified as factors associated with increased external pressure. There have been no compression-related complications in 534 cases at our institution since the introduction of intraoperative pressure monitoring. Several risk factors associated with increased external pressure on the lower leg were identified. Intraoperative pressure monitoring might help reduction of pressure-related complications, needing further and larger prospective data collections.

Well-leg compartment syndrome after laparoscopic surgery for rectal cancer: A case report.

Introduction and importanceWell-leg compartment syndrome (WLCS) develops from abnormal positioning of the limb during surgery. There have been few reports of WLCS in rectal cancer patients, although the lithotomy position, which is widely applied for rectal surgery, is a risk factor for WLCS.Case presentationA 56-year-old man with rectal cancer underwent laparoscopic low anterior resection of the rectum, left lateral lymph node dissection and diverting ileostomy. The operation time was 393 min. The patient was in the head-down tilt lithotomy position and rotated to the right side. Postoperatively, he complained of left lower leg pain and swelling and difficulty moving his legs. The compartment pressure of his right and left lower legs was 80 mmHg and 120 mmHg, respectively. A diagnosis of bilateral WLCS was made, and fasciotomy of both lower legs was performed 2 h after surgery. Although he was able to live his daily life, mild numbness remained in his toes one year after surgery.Clinical discussionIn addition to risk factors previously reported for WLCS, our review shows that the male sex and left side are associated with a greater risk of WLCS, especially in rectal surgery. Additionally, our review reveals that the type of rectal surgery leading to WLCS is almost always laparoscopic surgery.ConclusionSurgeons should be especially vigilant for WLCS when they encounter patients, especially males, who complain of left lower leg pain after laparoscopic rectal surgery.

'Well-leg' compartment syndrome associated with gynaecological surgery: a perioperative risk-reduction protocol and checklist.

'Well-leg' compartment syndrome (WLCS) is an uncommon, but potentially devastating, complication associated with prolonged patient positioning for abdomino-pelvic surgery. Gynaecologists, anaesthetists and the wider theatre team share a responsibility to minimise the risk of this highly morbid, and even fatal, postoperative complication. This article provides an overview of WLCS related to gynaecological surgery - raising awareness amongst gynaecologists and highlighting the time-critical nature of diagnosis and management. Given the potential litiginous nature of this complication, we also present a perioperative checklist and risk-reduction protocol to suggest a standardised approach to prevention and relevant documentation. TWEETABLE ABSTRACT: Gynaecologists share a responsibility to minimise the risk of postoperative 'well-leg' compartment syndrome.

Well leg compartment syndrome following robot-assisted radical cystectomy in the lithotomy position: a case report

BackgroundThe indications for robot-assisted urologic surgeries have expanded due to their low invasiveness. However, complicated surgical procedures lead to prolonged surgical duration, requiring patients to remain in the lithotomy position for an extended time. Well leg compartment syndrome (WLCS) is a known severe postoperative complication related to the lithotomy position.Case presentationWe report a case of WLCS after robot-assisted radical cystectomy (RARC), in which the patient recovered without neurological sequelae. A 55-year-old, obese male who underwent RARC complained of right leg pain and paresthesia 3 h after the surgery that lasted for 481 min. Emergency evaluation revealed unilateral WLCS in the anterior and lateral compartments. Urgent fasciotomy was performed 4 h after symptom onset. He thereafter recovered completely and was discharged without any neuromuscular dysfunction.ConclusionsEarly detection of WLCS, surgical treatment, and additional measures are crucial to prevent its life-threatening and/or disabling outcomes.

Well-leg compartment syndrome – a case report and relevance to orthognathic surgery

Well-leg compartment syndrome – a case report and relevance to orthognathic surgery

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

PurposeCompartment syndrome that occurs after lengthy surgery in the lithotomy position is known as well-leg compartment syndrome. It has serious consequences for patients, including amyotrophic renal failure, limb loss, and sometimes even death. This study aimed to identify effective preventive measures against well-leg compartment syndrome using a retrospective cohort study of 1,951 patients (985 and 966 in the prevention and control groups, respectively). Material and methodsThe following preventive interventions were analyzed: (1) changing from the lithotomy position to the open-leg position, (2) removing lower leg pressure caused by the lithotomy position, (3) limiting leg elevation based on the height of the right atrium, (4) horizontally repositioning the operating table every 3 hours, and (5) decompressing the contact area of the lower leg in the lithotomy position during operation. ResultsEight cases of well-leg compartment syndrome occurred in the control group, whereas no well-leg compartment syndrome occurred in the prevention group. ConclusionThese findings suggest that the five interventions assessed can prevent the development of well-leg compartment syndrome.

Prevention of Well-Leg Compartment Syndrome Following Lengthy Operations in the Lithotomy Position

Purpose: Compartment syndrome that occurs after lengthy surgery in the lithotomy position is known as well-leg compartment syndrome (WLCS). WLCS has serious consequences for patients; these include amyotrophic renal failure, limb loss, and sometimes even death. This study aimed to identify effective preventive measures against WLCS using a retrospective cohort study of 1,951 patients (985 and 966 in the prevention and control groups, respectively). Material and Methods: The following preventive interventions were analyzed: 1) changing from the lithotomy position to the open-leg position, 2) removing lower leg pressure caused by the lithotomy position, 3) limiting leg elevation based on the height of the right atrium, 4) horizontally repositioning the operating table every 3 hours, and 5) decompressing the contact area of the lower leg in the lithotomy position during operation. Results: Eight cases of WLCS occurred in the control group, while no WLCS occurred in the prevention group. Conclusions: These findings suggest that the five interventions assessed can prevent the development of WLCS.

External pressure at calf region in low lithotomy position is higher in men and increases proportionately with height, weight, lower leg size, and foot length

ObjectivePatients placed in lithotomy position (LP) with a leg holder during surgical procedures have been at particular risk of developing well leg compartment syndrome (WLCS). A commonly considered contributing factor of WLCS is obesity. LP is mainly divided into the following four types by the degree of hip angulation and height of lower leg placement relative to the heart: low, standard, high, and exaggerated. We have reported that the external pressure at the calf region in standard LP is independent of weight. In the present study, we investigated the relationship between the external pressure in low LP and physical characteristics, such as body, leg, and foot sizes. MethodsFifty-five volunteers, 27 men and 28 women, participated in this study. They were placed in low LP with the boot-support-type leg holder, with the hip joints flexed at 170° from the trunk and abducted at 45°, and with the knee joints flexed at 120°. Peak contact pressure (PCP) at the calf region was measured as representative external pressure by using the pressure distribution measurement system, BIG-MAT®. ResultsThe mean PCPs at the left and right calf regions in men (37.6 and 39.3 mmHg, respectively) were significantly higher than those in women (31.5 and 33.6 mmHg [P = 0.014 and 0.001], respectively). The left PCPs correlated positively with height (P = 0.003), weight (P = 0.001), body mass index (BMI) (P = 0.037), tibial length (TL) (P < 0.001), bimalleolar breadth (BB) (P = 0.046), maximum calf girth (MCG) (P = 0.035), and foot length (FL) (P = 0.001); and the right PCPs correlated positively with height (P < 0.001), weight (P < 0.001), BMI (P = 0.063), TL (P < 0.001), BB (P = 0.001), MCG (P = 0.005), and FL (P = 0.001). ConclusionThe external pressure at the calf region in low LP is higher in men and increases proportionately with height, weight, lower leg size, and FL, which may contribute to the risks of inducing WLCS during surgeries performed in low LP.

Well leg compartment syndrome in trauma surgery - femoral shaft fracture treated by femoral intramedullary nailing in the hemilithotomy position: case series and review of the literature.

Well leg compartment syndrome (WLCS) is a rare complication which can occur following urological, gynecological, general surgical or orthopedic surgeries carried out with the lower limb in the hemilithotomy position. WLCS is associated with significant morbidity and mortality because delay in diagnosis and treatment can lead to loss of function and even life-threatening complications. During orthopedic surgeries on a traction table, such as femoral nailing, the contralateral “well leg” is often placed in the hemilithotomy position, thus facilitating the use of fluoroscopy. This position (also named the Lloyd-Davis position) consists of hip flexion, abduction, external rotation and knee flexion. We present the cases of two teenaged patients who underwent femoral nailing on an extension table of a femoral fracture and developed WLCS. We also present a review of the literature and a discussion of the pathophysiology, risk factors and treatment of this condition. Clinicians need to be aware of the risk factors for WLCS and have high index of suspicion. Further studies looking at the risks, benefits and feasibility of ways to reduce this risk are required.

Well Leg Compartment Syndrome after Cystectomy in the Lithotomy Position: A Case Report

Well leg compartment syndrome (WLCS) is an uncommon and severe complication that occurs after prolonged surgery in the lithotomy position. A 67-year-old male with bladder cancer who underwent cystectomy including ileal conduit construction in the lithotomy position developed severe, gradually worsening cramping pain in the right leg on the day after surgery. The posterior compartmental pressure of the right leg was high (40 mmHg), and WLCS was diagnosed. Emergency fasciotomy was followed by rehabilitation for one month and he recovered from motor or sensory deficits, but the pain continued. We considered that important factors associated with the development of WLCS in this patient were arteriosclerosis obliterans and the length of time during which he remained in the lithotomy position during the ileal conduit procedure. We consider thatlengthy surgical procedures for cystectomy with patients in the lithotomy position have high potential for inducing WLCS.

Well-leg compartment syndrome following internal hemipelvectomy and reconstruction with three-dimensional printed implant in the management of pelvic Ewing sarcoma

Well-leg compartment syndrome following internal hemipelvectomy and reconstruction with three-dimensional printed implant in the management of pelvic Ewing sarcoma

Well Leg Compartment Syndrome After Abdominal Surgery.

Well leg compartment syndrome (WLCS) is a complication to abdominal surgery. We aimed to identify risk factors for and outcome of WLCS in Denmark and literature. Prospectively collected claims to the Danish Patient Compensation Association (DPCA) concerning WLCS after abdominal operations 1996-2013 and cases in literature 1970-2013 were evaluated. Cases of fasciotomy within 2weeks after abdominal surgery 1999-2008 were extracted from the Danish National Patient Register (DNPR). There were 40 cases in DPCA and 124 in literature. In 68% legs were supported under the knees during surgery. Symptoms of WLCS presented within 2h after surgery in 56% and in only 3 cases after 24h. Obesity was not confirmed as risk factor for WLCS. The mean diagnostic delay was 10h. One-third of fasciotomies were insufficient. The diagnostic delay increased with duration of the abdominal surgery (p=0.04). Duration of the abdominal surgery was 4 times as important as the diagnostic delay for severity of the final outcome. DNPR recorded 4 new cases/year, and half were reported to DPCA. The first 24h following abdominal surgery of >4h' duration with elevated legs observation for WLCS should be standard. Pain in the calf is indicative of WLCS, and elevated serum CK can support the diagnosis. Mannitol infusion and acute four-compartment fasciotomy of the lower leg is the treatment. The risk of severe outcome of WLCS increases with duration of the primary operation. A broad support and change of legs' position during surgery are suggested preventative initiatives.