Medline ® Abstracts for References 16,17

PURPOSE: Acute compartment syndrome in patients undergoing prolonged colorectal procedures is uncommon but can have catastrophic consequences for the patient with the development of metabolic acidosis, myoglobinuric renal failure, Volkmann's contracture, limb loss, and death. The potential to produce long-term disability in a patient has important medicolegal implications, particularly if the complication is avoidable. Why only some patients develop acute compartment syndrome is not fully understood. The purpose of this study was to highlight current knowledge and suggested prevention strategies.

METHODS: A review of the relevant English language articles was performed on the basis of a MEDLINE search of the keywords: acute compartment syndrome, lithotomy position, reperfusion injury, and fasciotomy.

RESULTS: Different factors play a role: lithotomy position with or without head down, ankle and knee position, external compression for deep vein thrombosis prophylaxis, method of leg support, duration of surgery, and physiologic factors, such as gender, age, and body mass index. All efforts should be directed to preventthe establishment of acute compartment syndrome and there are accepted suggestions, such as limiting the time of leg elevation, positioning the leg below the atrium level, and monitoring postoperatively patients at risk. There is still debate on the intraoperative use of pulse oximetry to detect hypoperfusion and the appropriate use of sequential compression devices and antithromboembolic stockings.

CONCLUSIONS: Acute compartment syndrome is uncommon but cases have been reported after prolonged pelvic procedures in the lithotomy position and it is a preventable condition. More research is required to set clear guidelines on patient positioning during surgery.

Methanol intoxication is infrequent even though it is easily obtainable. One of the complications in locomotor apparatus is the development of a compartment syndrome of the lower extremities. A case is reported of a 49-year-old man with a compartment syndrome in all compartments of both legs and the anterior compartment of both thighs due to methanol intoxication. The patient underwent a bilateral fasciotomy of the legs and thighs. He also had haemodialysis sessions because of acute renal insufficiency. After 4 weeks of haemodialysis, covering of the fasciotomies with cutaneous autograft and rehabilitation treatment, the patient was able to walk on his own again. Early recognition and treatment of compartment syndrome are essential to avoid complications.