Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2021; 48(05): 543-546
DOI: 10.5999/aps.2020.02397
Extremity/Lymphedema
Case Report

Acute limb ischemia following perineal reconstruction in lithotomy position: take-home message for plastic surgeons

Gianluca Sapino 
Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
,
Sebastien Deglise 
Department of Vascular Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
,
Wassim Raffoul 
Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
,
Pietro G. di Summa 
Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Despite the extensive use of lithotomy position in several plastic surgery procedures, most reports regarding the related incidence of complications are presented in the urologic, gynecologic, and anesthesiologic fields. We present the case of a 54-year-old male patient. polytrauma patient who underwent internal iliac artery embolization leading to extensive gluteal necrosis requiring: debridement, abdominoperineal resection and composite anterolateral thigh flap reconstruction with prolonged lithotomy position. The patient presented lower limb ischemia briefly after surgical theater. A computed tomography scan revealed the obstruction of the left superficial femoral artery requiring emergency revascularization. Arterial thrombosis is a potentially devastating complication and plastic surgeons should be aware of the possible dangers when performing surgeries in prolonged lithotomy position. Preoperative detection of patients at high risks for developing complications should be performed in order to implement preventive measures and avoid potentially life-threatening sequelae.

Keywords

Reconstructive surgical procedure - Surgery, plastic - Limb ischemia


Publication History

Received: 10 December 2020

Accepted: 25 May 2021

Article published online:
19 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • REFERENCES

  • 1 Bauer EC, Koch N, Janni W. et al. Compartment syndrome after gynecologic operations: evidence from case reports and reviews. Eur J Obstet Gynecol Reprod Biol 2014; 173: 07-12
    CrossrefPubMedGoogle Scholar
  • 2 Gelder C, McCallum AL, Macfarlane AJR. et al. A systematic review of mechanical thromboprophylaxis in the lithotomy position. Surgeon 2018; 16: 365-71
    CrossrefPubMedGoogle Scholar
  • 3 Yanazume S, Yanazume Y, Iwamoto I. et al. Severe leg compartment syndrome associated with dorsal lithotomy position during radical hysterectomy. J Obstet Gynaecol Res 2006; 32: 610-02
    CrossrefPubMedGoogle Scholar
  • 4 Sahara K, Ishibe A, Yabuno T. et al. Acute iliac arterial thrombosis during laparoscopic abdominoperineal resection. J Surg Case Rep 2019; 2019: rjz020
    PubMedGoogle Scholar
  • 5 Canterbury TD, Wheeler WE, Scott-Conner CE. Effects of the lithotomy position on arterial blood flow in the lower extremities. W V Med J 1992; 88: 100-01
    PubMedGoogle Scholar
  • 6 di Summa PG, Tremp M, Meyer Zu Schwabedissen M. et al. The combined pedicled anterolateral thigh and vastus lateralis flap as filler for complex perineal defects. Ann Plast Surg 2015; 75: 66-73
    CrossrefPubMedGoogle Scholar
  • 7 Angermeier KW, Jordan GH. Complications of the exaggerated lithotomy position: a review of 177 cases. J Urol 1994; 151: 866-08
    CrossrefPubMedGoogle Scholar
  • 8 Halliwill JR, Hewitt SA, Joyner MJ. Effect of various lithotomy positions on lower-extremity blood pressure. Anesthesiology 1998; 89: 1373-06
    CrossrefPubMedGoogle Scholar
  • 9 Nakamura K, Aoki H, Hirakawa T. et al. Compartment syndrome with thrombosis of common iliac artery after gynecologic surgery. Obstet Gynecol 2008; 112 2 Pt 2 486-08
    CrossrefPubMedGoogle Scholar
  • 10 Kikuchi T, Maeda H. Two cases of compartment syndrome of the lower extremities during surgery for gynecological malignancies. J Anesth 2016; 30: 481-05
    CrossrefPubMedGoogle Scholar
  • 11 Creager MA, Kaufman JA, Conte MS. Clinical practice: acute limb ischemia. N Engl J Med 2012; 366: 2198-206
    CrossrefPubMedGoogle Scholar