![]() There should be a low threshold for reassessment in patients whose symptoms persist or deteriorate.Treatment should be under way within 1 h of diagnosis. If clinical assessment confirms a definite or likely diagnosis of WLCS, this is a limb/life-threatening surgical emergency requiring immediate decompression by open four-compartment fasciotomy.If WLCS is suspected, immediate referral should be made to the orthopaedic or vascular surgery team, according to local protocols.Assessment of sensation, pulses and capillary refill.Passive stretch exacerbation of pain: dorsiflexion of toes, plantar flexion of toes, dorsiflexion/plantar flexion of ankle.Palpation: tension in compartments, palpable difference between sides tenderness in each compartment.Inspection: swelling – unilateral/bilateral, oedema.Accurate history – pain, paraesthesia, numbness, weakness, paralysis.The initial diagnosis of WLCS is entirely clinical, so assessment of the patient with suspected WLCS must be methodical, focused and thorough, and documented clearly and contemporaneously.Any patient who has undergone pelvic surgery in the lithotomy position, whether or not combined with Trendelenberg tilt, who complains of postoperative leg pain should be suspected of having WLCS.Intraoperative hypotension should be corrected where possible and intraoperative fluid therapy optimized to avoid both excessive fluid administration, or inadequate tissue perfusion.The duration of elevation and the time allowed for recovery should be monitored and documented in the patient's operation note/anaesthetic chart. The patient's legs should be kept at a lower level than the heart for a minimum of 15 min after each 4-h interval. Where elevation of the legs is required to facilitate surgery, the maximum unbroken period of elevation should not exceed 4 h.Unless mandated by other patient safety considerations, the patient's legs should be kept at a level below the heart for the maximum duration possible during a procedure.Strategies agreed to minimize the risk to each patient must be recorded before commencement of surgery. The risk of WLCS must be noted specifically in the preoperative team brief and WHO time out.All surgeons who undertake pelvic procedures on patients maintained in the Lloyd-Davies/lithotomy positions should be aware of well leg compartment syndrome (WLCS).ConclusionĪll surgeons who carry out abdominopelvic surgical procedures should be aware of well leg compartment syndrome, and instigate policies within their own institution to reduce the risk of this potentially life-changing complication. ![]() Key recommendations for the adoption of perioperative strategies to facilitate prevention and effective treatment of well leg compartment syndrome are presented. These guidelines encompass the risk factors (both patient- and procedure-related), diagnosis and management of the condition. A systematic analysis of the available peer-reviewed literature was undertaken to provide an evidence base from which these guidelines were developed. These guidelines represent the collaboration of a multidisciplinary group of colorectal, vascular and orthopaedic surgeons, acting on behalf of their specialty associations in the UK and Ireland. This condition may have devastating consequences for postoperative recovery, including loss of life or limb, and irreversible disability. Patients undergoing prolonged pelvic surgery may develop compartment syndrome of one or both lower limbs in the absence of direct trauma or pre-existing vascular disease (well leg compartment syndrome).
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