![]() ![]() It has been described that lithotomy position, in general surgical, urological and orthopaedic patients, is associated with changes in intracompartmental pressure that may eventually develop a compartment syndrome, especially in prolonged surgeries. ![]() Therefore, it is essential to consider the possibility of this complication in a patient presenting symptoms compatible with compartment syndrome. ![]() 1 A failure of delay in diagnosis may result in adverse outcomes for the patient, 2 which can even lead to an admission to an Intensive Care Unit with a renal failure subsidiary of renal replacement therapy or even death. Keywords: well-leg compartment syndrome, percutaneous nephrolithotomy, Galdakao-modified supine Valdivia positionĪcute compartment syndrome of the leg occurs following a rise in the pressure inside the muscle compartment. It should be suspected in cases with risk factors and compatible clinical symptoms and signs, and treated rapidly to avoid further complications. Risk factors include obesity, peripheral vascular disease (advanced age, hypertension, hyperlipidemia and diabetes mellitus), height, hypothermia, acidemia, BMI, male sex, combined general-spinal anesthesia, prolonged surgery time, systemic hypotension, ASA (American Society of Anesthesiologists) class, lack of operative experience, vasoconstricting drugs, important bleeding during the surgery and increased muscle bulk.Ĭonclusion: Compartment syndrome is a potentially life-threatening complication that may occur in the Galdakao-modified supine Valdivia position. Therefore, this complication must be suspected and early decompression of the compartment must be performed. It may lead to skin necrosis, permanent neuromuscular dysfunction, myoglobinuric renal failure, amputation and even death. The compartment syndrome is a rare complication in lithotomy position, but never described in the Galdakao-modified supine Valdivia position before, with the lower limbs in moderate flexion, and with the ipsilateral lower limb in a slightly inferior position with respect to the other. Six months after the episode, the patient still needs rehabilitation care. The patient was taken to the intensive care unit. After the surgery, values of creatine phosphokinase reached 80.000 UI/L and serum creatinine levels were 1.53 mg/dL. Suspecting compartment syndrome, the patient underwent a complete decompression fasciotomy of the four left leg compartments. Doppler ultrasound ruled out venous thrombosis. The limb appeared oedematous and cyanotic, although pedis pulses were preserved. In the immediate postoperative period, significant pain was reported in the left lower limb. The patient was positioned in the Galdakao-modified supine Valdivia position, with lower limbs bandaged, to perform a right percutaneous nephrolithotomy. Results: The case of a 32-year-old male, obese (105 Kg) and a former smoker is presented. Purpose: The objective is to present a case of well-leg compartment syndrome in the Galdakao-modified supine Valdivia position. Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Carretera de Colmenar Km 9.100, Madrid 28029, Spain Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain Inés María Laso-García, Fernando Arias-Fúnez, Gema Duque-Ruiz, David Díaz-Pérez, Javier Lorca-Álvaro, Francisco Javier Burgos-Revilla ![]()
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