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abstract
"Compartment syndrome (CS) of the lower leg is a rare
but severe complication of operations in the lithotomy (LT) position
after urologic, gynecologic and general surgery. A delay in diagnosis
and treatment can lead to loss of function and even life-threatening
complications. The pathophysiology is still not fully understood but it
is believed that ischemia as a result of increased compartment pressure
and decreased perfusion pressure may lead to CS. The type of leg support
and intraoperative hypotension have been discussed as risk factors but
evidence is mainly based on case reports and expert opinion. Studies
suggest that time spent in the LT position and the addition of head-down
tilt are associated with CS. As these positions are routinely applied
during various gynecologic procedures, forensically CS has to be
considered as a specific complication of gynecologic surgery in the LT
position. Despite the low incidence there is a need for prospective
studies and guidelines for its prevention.
Sixteen
case reports describing 19 cases of CS following gynecologic surgery in
lithotomy position were found during a literature search. This review is
based on 14 of these case reports (17 cases), which describe a
postoperative compartment syndrome in a previously healthy leg. We
summarize the reported cases and literature on CS after gynecologic
procedures in order to increase awareness among medical staff and to
give careful recommendations regarding perioperative management based on
available information."
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