Christoffersen et al reported risk factors for well leg compartment syndrome (WLCS) following abdominal surgery. The authors are from Danish Patient Compensation Association, Hvidovre Hospital and Bispebjerg-Frederiksberg Hospital in Denmark.

Patient selection: abdominal surgery


Proposed mechanism: ischemia with reperfusion, causing muscle swelling


Clinical features:

(1) onset of symptoms 12-48 hours of surgery

(2) pain in the calf

(3) elevated serum CK


Key risk factors:

(1) elevated legs during surgery, especially when> 4 hours

(2) longer duration of surgery


Additional risk factors may include:

(1) method of elevating the legs (greater with compression of vessels and nerves)

(2) anti-thrombotic compression stockings


Acute four-compartment fasciotomy of the lower leg is the usual management.

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