scholarly journals Bilateral compartment syndrome of the lower limbs after urological surgery in the lithotomy position: a clinical case

2019 ◽  
Vol 18 ◽  
Author(s):  
José Maciel Caldas dos Reis ◽  
Lauro José Mendes Queiroz ◽  
Pablo Ferreira Mello ◽  
Renan Kleber Costa Teixeira ◽  
Fábio de Azevedo Gonçalves
Keyword(s):  
Compartment Syndrome ◽  
Wound Closure ◽  
Early Recognition ◽  
Acute Compartment Syndrome ◽  
Lower Limbs ◽  
Lithotomy Position ◽  
Activity Levels ◽  
Urological Surgery ◽  
Baseline Activity

Abstract Acute compartment syndrome of the lower extremities after urological surgery in the lithotomy position is a rare but potentially devastating clinical and medicolegal problem. We report the case of a 67-year-old male who underwent laparoscopic prostatectomy surgery to treat cancer, spending 180 minutes in surgery. Postoperatively, the patient developed acute compartment syndrome of both legs, needing emergency bilateral four-compartment fasciotomies, with repeated returns to the operating room for second-look procedures. The patient also exhibited delayed wound closure. He regained full function within 6 months, returning to unimpaired baseline activity levels. This report aims to highlight the importance of preoperative awareness of this severe complication which, in conjunction with early recognition and immediate surgical management, may mitigate long-term adverse sequelae and improve postoperative outcomes.

scholarly journals Early morbidity associated with fasciotomies for acute compartment syndrome in children

2018 ◽  
Vol 12 (5) ◽  
pp. 480-487 ◽  
Author(s):  
K. B. L. Lim ◽  
T. Laine ◽  
J. Y. Chooi ◽  
W. K. Lye ◽  
B. J. Y. Lee ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Compartment Syndrome ◽  
Wound Closure ◽  
Case Series ◽  
Skin Grafting ◽  
Acute Compartment Syndrome ◽  
Inpatient Stay ◽  
Wound Infections ◽  
Short Term ◽  
Level Of Evidence

Purpose Acute compartment syndrome (ACS) requires urgent fasciotomy to decompress the relevant muscle compartment/s prior to onset of irreversible myonecrosis and nerve injury. A fasciotomy is not a benign procedure. This study aims to describe and quantify early morbidity directly associated with fasciotomies for ACS in children. Methods Clinical charts of 104 children who underwent 112 fasciotomies over a 13-year period at a tertiary children’s hospital were reviewed. The following were analyzed: ACS aetiology, fasciotomy site, number of subsequent procedures, method of wound closure, short-term complications and length of hospital stay. Results Short-term complications included wound infections (6.7%) and the need for blood transfusion (7.7%). Median number of additional operations for wound closure was two (0 to 10) and median inpatient stay was 12 days (3 to 63; SD 11.7). After three unsuccessful attempts at primary closure, likelihood of needing skin grafting for coverage exceeded 80%. Analyses showed that fasciotomy-wound infections were associated with higher risk for four or more closure procedures. Number of procedures required for wound closure correlated with longer inpatient stay as did ACS associated with non-orthopaedic causes. Conclusion Fasciotomy is associated with significant early morbidity, the need for multiple closure operations, and prolonged hospital stay. The decision for fasciotomy needs careful consideration to avoid unnecessary fasciotomies, without increasing the risk of permanent injury from missed or delayed diagnosis. Skin grafting should be considered after three unsuccessful closure attempts. Less invasive tests or continuous monitoring (for high-risk patients) for compartment syndrome may help reduce unnecessary fasciotomies. Level of Evidence Level IV, Case series

scholarly journals Compartment Syndrome Related to Patient Positioning in the Surgical Treatment of Urolithiasis

2021 ◽  
Author(s):  
Inés Laso-García ◽  
Fernando Arias-Fúnez ◽  
Gemma Duque-Ruiz ◽  
David Díaz-Pérez ◽  
Alberto Artiles-Medina ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Compartment Syndrome ◽  
Percutaneous Nephrolithotomy ◽  
Rare Complication ◽  
Patient Positioning ◽  
Lower Limbs ◽  
Urinary Stones ◽  
Ureteral Stones ◽  
Lithotomy Position ◽  
American Society

The incidence of urolithiasis is progressively increasing worldwide, as is the surgical treatment of urinary stones. The most frequent surgery for urolithiasis is ureterorenoscopy, which is performed in the lithotomy position. This position is also used in the endoscopic approach to bladder stones. Lateral decubitus is rarely used in the treatment of urinary stones. In the case of complex kidney stones, the gold standard treatment is percutaneous nephrolithotomy. This surgery has traditionally been performed in the prone position. However, the use of the supine (Valdivia) position is increasing in recent times. Furthermore, the Galdakao-modified supine Valdivia position has been widely used for percutaneous nephrolithotomy since it was described by Ibarluzea et al. in 2007. Treatment of kidney and ureteral stones simultaneously is allowed in both supine positions. In addition, they allow the removal of encrusted stents and the easy placement of double J stents and, in the case of the Galdakao-modified supine Valdivia position, percutaneous nephrostomies. Compartment syndrome is a rare complication in the lithotomy position, but scarcely described in the supine position. This especially applies to the Galdakao-modified supine Valdivia position, in which the lower limbs are in moderate flexion, with the ipsilateral lower limb in a slightly lower position relative to the other. This complication can lead to skin necrosis, myoglobinuric renal failure, amputation, permanent neuromuscular dysfunction, and even death. Risk factors include Body Mass Index, male gender, obesity, increased muscle mass, peripheral vascular disease (advanced age, hypertension, hyperlipidemia and diabetes mellitus), height, lack of operative experience, significant bleeding during surgery, hypothermia, acidemia, combination general-spinal anesthesia, prolonged surgical time, systemic hypotension, ASA (American Society of Anesthesiologists) class or vasoconstrictor drugs. Therefore, compartment syndrome of the leg is a potentially devastating complication that must be suspected and treated through early decompression of the compartment by four compartment fasciotomy. Preventive measures reduce the incidence of this condition.

Evaluation of Strength Recovery after Traumatic Acute Compartment Syndrome of the Thigh. A Case Study

2017 ◽  
Vol 19 (4) ◽  
pp. 0-0
Author(s):  
Alban Fouasson-Chailloux ◽  
Pierre Menu ◽  
Marc Dauty
Keyword(s):  
Compartment Syndrome ◽  
Acute Compartment Syndrome ◽  
Intramuscular Pressure ◽  
Rehabilitation Care ◽  
Fracture Reduction And Fixation ◽  
Strength Recovery ◽  
Prompt Diagnosis

Acute compartment syndrome of the thigh is an underestimated serious pathology which can cause long term morbidities. The management, recovery and follow-up of the case of a 20-year-old Caucasian man, who presented an acute compartment syndrome of the thigh, are described. After femoral fracture reduction and fixation by nail, intramuscular pressure measurements confirmed the diagnosis before treatment by fasciotomies. 12-months’ follow-up showed the presence of neurological femoral complications and physical impairment in spite of rehabilitation care. Because compartment syndrome of the thigh after a trauma is rare but potentially devastating, prompt diagnosis is required for performing early fasciotomies.

scholarly journals The Pathophysiology, Diagnosis and Current Management of Acute Compartment Syndrome

2014 ◽  
Vol 8 (1) ◽  
pp. 185-193 ◽  
Author(s):  
James Donaldson ◽  
Behrooz Haddad ◽  
Wasim S Khan
Keyword(s):  
Compartment Syndrome ◽  
Tissue Perfusion ◽  
Surgical Decompression ◽  
Acute Compartment Syndrome ◽  
Definitive Treatment ◽  
Interstitial Pressure ◽  
Compartment Pressure ◽  
Current Management ◽  
Ischaemic Damage

Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of ‘pain out of proportion to the injury’. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. If symptoms persist, definitive treatment is necessary with timely surgical decompression of all the involved compartments. This article reviews the pathophysiology, diagnosis and current management of ACS.

scholarly journals Can Extravasation Injury Cause Subcutaneous Compartment Syndrome of the Hand?

2017 ◽  
Vol 3 ◽  
pp. 2513826X1772825
Author(s):  
Victor W. Wong ◽  
Philip J. Hanwright ◽  
Michele A. Manahan
Keyword(s):  
Compartment Syndrome ◽  
Tissue Perfusion ◽  
Acute Compartment Syndrome ◽  
Tissue Loss ◽  
Rapid Improvement ◽  
Subcutaneous Space ◽  
Cutaneous Perfusion ◽  
Compartment Pressures

Background: Compartment syndrome of the hand is a well-described phenomenon with potentially devastating consequences. Although numerous mechanisms have been proposed, the extravasation of peripheral intravenous (IV) fluids remains a relatively rare etiology. Objective: Surgical dogma mandates emergent decompressive fasciotomies in the presence of hand dysfunction and impending tissue loss from supraphysiologic compartment pressures. The role of the subcutaneous space in acute compartment syndrome remains unclear. Methods: In this report, we present a case of a dorsal hand IV extravasation leading to an acute compartment syndrome of the subcutaneous space. Results: An emergent skin-only incision was used for decompression, with immediate improvement in symptoms and no long-term adverse sequelae. Discussion: The subcutaneous space appears capable of sustaining supraphysiologic pressures that impair cutaneous perfusion. This closed anatomic space can be readily decompressed, resulting in rapid improvement in soft tissue perfusion. However, its role in contributing to acute compartment syndrome of the hand requires further research. Conclusion: We propose consideration of the subcutaneous space as a distinct hand compartment and advocate selective compartment release when prudent.

scholarly journals Acute Lower Leg Compartment Syndrome: A Rare Complication following CABG

2016 ◽  
Vol 2016 ◽  
pp. 1-2 ◽  
Author(s):  
Muazzam Tahir ◽  
Sean Galvin
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Compartment Syndrome ◽  
Early Recognition ◽  
Rare Complication ◽  
Artery Bypass ◽  
Lower Leg ◽  
Bypass Grafting ◽  
Systemic Factors

Compartment syndrome of lower legs following coronary artery bypass grafting is a rare complication which results from a combination of local and systemic factors. Early recognition is vital for good outcome. The case discussed describes this rare complication of CABG resulting in long term disability.

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