PREVENTION OF COMPARTMENT SYNDROME-ASSOCIATED WITH THE DORSAL LITHOTOMY POSITION

There is a clear association between the dorsal lithotomy position and the development of a postoperative compartment syndrome. Compartment syndrome occurs when elevated pressure in an osteofascial compartment compromises local perfusion and often results in neurovascular damage and permanent disability. Surgeons must recognize this association and provide appropriate preventative measures, have a high index of suspi cion in all patients, and be prepared to make an early diagnosis when it is encountered. We will report four cases we encountered, discuss t he etiology, analyze the literature, and propose a modification on pat ient positioning that has minimized the incidence of compartment syndr ome at our institution. A variety of intraoperative events, including hypotension, hypoxemia, leg elevation, hip and knee flexion, direct pr essure, and compressive bandages may all contribute to compartmental i schemia. Ischemia is followed by reperfusion, capillary leakage from t he ischemic tissue, and a further increase in tissue edema. Increased edema causes further embarrassment of perfusion and perpetuation of th e cycle, ultimately resulting in neuromuscular compromise secondary to ischemia. To prevent this destructive cycle, emphasis must be placed on maintaining a high index of suspicion in all patients, minimizing l eg elevation, and on the importance of early diagnosis and interventio n.