Compartment syndrome following prolonged pelvic surgery.

Compartment syndrome is a rare but serious complication of prolonged pelvic surgery. Prompted by two recent cases the authors studied the effect of limb angulation and elevation on Doppler ankle artery pressure and compartment pressure in ten normal subjects. Mean ankle pressure when supine was 130.5 (95 per cent confidence interval (c.i.) 124.5-136.5) mmHg and fell to 77.2 (95 per cent c.i. 64.6-89.8) mmHg in the Lloyd-Davies position with 10 degrees of head-down tilt. Reversing table tilt to bring the ankle elevation to 0 degrees in Lloyd-Davies supports restored mean ankle pressure to 114.3 (95 per cent c.i. 105.5-122.9) mmHg (P < 0.001). Placing the lower limb in calf supports was found to increase the mean intracompartmental pressure from 3.0 (95 per cent c.i. 1.2-4.8) mmHg to 11.6 (95 per cent c.i. 9.1-14.1) mmHg. Reversing table tilt significantly restores limb perfusion in patients undergoing prolonged pelvic surgery with the legs elevated and may protect against subsequent compartment syndrome.