Well-Leg Compartment Syndrome After Percutaneous Nephrolithotomy in the Galdakao-Modified Supine Valdivia Position

Figures & data

Figure 1 CT scan showing the right staghorn lithiasis.

Figure 2 The Galdakao-modified supine Valdivia position.

Figure 3 Magnetic resonance imaging showing sequelae at 6 months.

Table 1 Risk Factors Associated with the Development of Compartment Syndrome Reported in the Literature

Related to the patient	Obesity
	Advanced age
	Hypertension
	Hyperlipidemia
	Diabetes Mellitus
	Height
	BMI
	Male sex
	ASA (American Society of Anesthesiologists) class
	Increased muscle bulk
Related to the surgery	Prolonged surgery time
	Systemic hypotension
	Acidemia
	Lack of operative experience
	Combined general-spinal anesthesia
	Hypothermia
	The use of vasoconstricting drugs
	Important bleeding during the surgery
	Wrapping elevated legs

Table 2 Surgical and Medical Treatment of Well-Leg Compartment Syndrome

Surgical treatment

If necessary, four compartments opening Long incisions (20–25 cm) along the length of the leg Complete release of all involved compartments Preservation of vital structures Necrotic tissue removal Avoidance of superficial peroneal nerve damage In muscles under tension: skin left open Use of moist dressings Skin incisions closing after a few days (for repeat irrigation and debridement)

Medical treatment

Adequate analgesia Early and aggressive fluid replacement Central venous monitoring Transferring to high dependency unit/intensive care therapy unit Adequately hydration (target urinary output of at least 0.5 mL/kg.) Use of mannitol (renal vasodilator effect, expands intravascular volume and decreases oxygen radicals) Urinary ph maintained as neutral as possible (avoidance urate and myoglobin precipitation): sodium bicarbonate or acetazolamide

Table 3 Fasciotomy Complications

Complication	Percentage
Dry scaly skin	40%
Discolored wounds	30%
Tethered scars	26%
Muscle herniation	13%
Pruritus	33%
Swollen limbs	25%
Recurrent ulceration	13%
Tethered tendons	7%
Appearance of scars causing discomfort	23%
Chronic venous insufficiency	–