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Bilateral well leg compartment syndrome associated with lithotomy (Lloyd Davies) position during gastrointestinal surgery: a case report and review of literature.

Chin KY, Hemington-Gorse SJ, Darcy CM - Eplasty (2009)

Bottom Line: We stress the importance to recognize high-risk patients for this complication and finding ways to reduce this risk.This is a possible complication of surgery associated with significant morbidity and mortality.Further studies looking at the risks, benefits and feasibility of suggestions on ways to reduce this risk is required.

View Article: PubMed Central - PubMed

Affiliation: Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom.

ABSTRACT

Introduction: Well leg compartment syndrome is a rare complication that can occur after prolonged surgery in lithotomy position. We stress the importance to recognize high-risk patients for this complication and finding ways to reduce this risk. We also emphasize high level of suspicion of at risk patients and early recognition of signs and symptoms to enable early diagnosis and treatment.

Methods: Presentation of a case report of bilateral well leg compartment syndrome with review of literature and discussion of the pathophysiology, risk factors and treatment of this condition.

Result: This is a possible complication of surgery associated with significant morbidity and mortality. Published papers have suggested possible ways to reduce this risk and achieve early diagnosis.

Conclusion: Clinicians should be aware of the aware of the risk factors for developing well leg compartment syndrome and in patients and have high index of suspicion when assessing them. Further studies looking at the risks, benefits and feasibility of suggestions on ways to reduce this risk is required.

No MeSH data available.


Related in: MedlinePlus

Fasciotomy wound post debridement in both legs.
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Figure 1: Fasciotomy wound post debridement in both legs.

Mentions: The patient was later transferred to the plastic surgery unit for the management of fasciotomy wounds. On examination postfasciotomy, the patient had sensory deficit in the distribution of superficial and deep peroneal nerves bilaterally. She had reduced power on plantar flexion and was unable to dorsiflex and evert both feet. The patient was taken to the operation theatre for debridement and exploration of fasciotomy wounds (Figs 1 and 2). In total, 7 debridements were carried out because the patient had progressive necrosis of her peroneal and anterior compartments, as well as necrosis of the left deep compartment involving the tibialis posterior muscle on the left. The right medial longitudinal wound was closed directly. VAC dressings were used for the other wound sites before they were closed with split-thickness skin graft proximally and directly on the distal part (Fig 3). The wound on the lateral left leg could not be primarily closed and a long length of fibula and posterolateral aspect of the tibia was exposed. Free flap surgery was not an option because this was the leg in which there had been a deep vein thrombosis. Over a period of 4 weeks, wound contraction and granulation tissue allowed complete coverage of the fibula. The posterolateral surface of the tibia was covered with skin and a layer of granulation tissue. After split-thickness skin graft was applied, the VAC dressing was reapplied for 5 days. The patient is now 2 months postdiagnosis and is mobilizing with the aid of 2 crutches. She requires orthotic splints bilaterally to correct her foot drop.


Bilateral well leg compartment syndrome associated with lithotomy (Lloyd Davies) position during gastrointestinal surgery: a case report and review of literature.

Chin KY, Hemington-Gorse SJ, Darcy CM - Eplasty (2009)

Fasciotomy wound post debridement in both legs.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2770805&req=5

Figure 1: Fasciotomy wound post debridement in both legs.
Mentions: The patient was later transferred to the plastic surgery unit for the management of fasciotomy wounds. On examination postfasciotomy, the patient had sensory deficit in the distribution of superficial and deep peroneal nerves bilaterally. She had reduced power on plantar flexion and was unable to dorsiflex and evert both feet. The patient was taken to the operation theatre for debridement and exploration of fasciotomy wounds (Figs 1 and 2). In total, 7 debridements were carried out because the patient had progressive necrosis of her peroneal and anterior compartments, as well as necrosis of the left deep compartment involving the tibialis posterior muscle on the left. The right medial longitudinal wound was closed directly. VAC dressings were used for the other wound sites before they were closed with split-thickness skin graft proximally and directly on the distal part (Fig 3). The wound on the lateral left leg could not be primarily closed and a long length of fibula and posterolateral aspect of the tibia was exposed. Free flap surgery was not an option because this was the leg in which there had been a deep vein thrombosis. Over a period of 4 weeks, wound contraction and granulation tissue allowed complete coverage of the fibula. The posterolateral surface of the tibia was covered with skin and a layer of granulation tissue. After split-thickness skin graft was applied, the VAC dressing was reapplied for 5 days. The patient is now 2 months postdiagnosis and is mobilizing with the aid of 2 crutches. She requires orthotic splints bilaterally to correct her foot drop.

Bottom Line: We stress the importance to recognize high-risk patients for this complication and finding ways to reduce this risk.This is a possible complication of surgery associated with significant morbidity and mortality.Further studies looking at the risks, benefits and feasibility of suggestions on ways to reduce this risk is required.

View Article: PubMed Central - PubMed

Affiliation: Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, United Kingdom.

ABSTRACT

Introduction: Well leg compartment syndrome is a rare complication that can occur after prolonged surgery in lithotomy position. We stress the importance to recognize high-risk patients for this complication and finding ways to reduce this risk. We also emphasize high level of suspicion of at risk patients and early recognition of signs and symptoms to enable early diagnosis and treatment.

Methods: Presentation of a case report of bilateral well leg compartment syndrome with review of literature and discussion of the pathophysiology, risk factors and treatment of this condition.

Result: This is a possible complication of surgery associated with significant morbidity and mortality. Published papers have suggested possible ways to reduce this risk and achieve early diagnosis.

Conclusion: Clinicians should be aware of the aware of the risk factors for developing well leg compartment syndrome and in patients and have high index of suspicion when assessing them. Further studies looking at the risks, benefits and feasibility of suggestions on ways to reduce this risk is required.

No MeSH data available.


Related in: MedlinePlus