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Well-Leg Compartment Syndrome — FRCA Final MCQ

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HardTrauma & Emergency AnaesthesiaWell-Leg Compartment SyndromeFRCA Final

A 50-year-old man (ASA II) is having a radical prostatectomy. He is positioned in the lithotomy/Trendelenburg position for 6 hours. Post-operatively he develops bilateral lower limb compartment syndrome. What is the mechanism?

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Correct answer: A — Tourniquet injury

Well-leg compartment syndrome is a recognised complication of prolonged surgery in the lithotomy or Lloyd Davies position (typically >4 hours). The mechanism involves reduced perfusion pressure to the lower limbs (legs elevated above the heart, reduced MAP from anaesthesia/epidural) combined with increased compartment pressure from venous congestion and the weight of the legs against the stirrups. The calf compartment is most commonly affected. Prevention: limit time in lithotomy, intermittent leg lowering, padded supports, and avoid excessive hip flexion. All patients should be assessed post-operatively.

Reference: AAGBI – 2018 – Perioperative positioning injuries; BOAST – 2014 – Compartment syndrome