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Wed Sep 6 20:37:42 BST 2006

Hello All..

What is the role of pnuematic compression stockings in this regard, which would seem to maintain the blood flow in the compromised circulation. The tredelenburg position along with the lithotomy position if positioned for long hours compromises the physiological circulation of blood to and from the legs. Do these pnuematic stockings have a role in DVT prophylaxis, and also a compartment syndrome occuring due to venous stasis??

Please opine.

Regards

Mandeep Singh
MBBS, MD Anaes
Senior Resident
AIIMS, New Delhi

On Wed, 06 Sep 2006 Ben Reynolds wrote :
>Having ran into this problem on two separate occasions
>(once for an elderly APR and another time for a 17
>year old girl free fibular graft to the hip for AVN) I
>don't think that perioperative pressure monitoring
>would be of benefit.
>
>The compartment syndrome occurs when the legs are
>lowered out of the stirrups and reperfusion occurs.
>If you compress the calves perioperatively (in my
>experience) they almost NEVER are firm.  Once you
>lower them, they get plump.  As far as I'm concerned,
>even in the unconscious patient, the best marker for
>fasciotomy in cases of suspected compartment syndrome
>is physical exam.  Regret is rare for a surgeon who
>fasciotomizes early when the exam suggests it.
>
>What works is good positioning on Allen stirrups with
>attention to keeping joint angles as ergonomic as
>possible and neurotically padding problem areas.
>
>Ben Reynolds, PA-C
>Pittsburgh, PA
>
>
>
>--- johan.malmgren at vgregion.se wrote:
>
>
>---------------------------------
>List!
>Would be grateful for some input although a bit off
>topic.
>20 y/o boy reoperated upon yesterday with a
>urethroplasty, buccal graft. Otherwise healthy, I'd
>guess 1.85 cm/85 kg.
>At earlier similar operation it had been noted a
>tendency for decubitus, so everybody took extra
>precautions. Operation lasted some 15 hours, under
>which the legs were lowered a couple of times, and I
>even think a nurse massaged them. BP was steady as a
>rock the entire time, no need for inotropic drugs.
>Still develops bilateral compartment-syndrome and was
>bilat fasciotomied later same night.
>
>The discussion today was of course prevention, and the
>question raised was if we should routinely have ortho
>come and measure pressure perioperatively during these
>kind of operations. (I guess the same would apply for
>some robotic-surgery operations were the patient
>almost hangs upside down) On the other hand, as far as
>I know, that would tell us when to open his legs and
>in an elective case like this, that already seems "too
>late".
>Any ideas? Would be happy to hear what your local
>routines tells about this!
>
>/Johan Malmgren
>MD, Anaesthesia and Critical Care/Trauma
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