在长期手术中以平卧位防止下肢定位损伤的策略:我们的技术和生殖器性别确认手术后的临床结果

Sandhu Sandeep S, Mallavarapu Samhita, Smith Shannon M, Garcia Maurice M
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摘要

目的:在背侧截石术(DL)体位下长时间手术造成的下肢(LE)损伤通常会影响患者的短期和长期生活质量。这些损伤包括下肢压疮、神经病变、横纹肌溶解症和隔室综合征。与其他手术相比,接受生殖器性别确认手术(gGAS)的患者面临的风险更大,因为这类手术的复杂程度高,手术时间相对较长。我们的研究旨在描述我们在 DL 体位下预防 LE 损伤的技术,并评估与体位相关的术后并发症和发生率。材料和方法:我们描述了背侧截石位的定位技术,重点是预防损伤。我们确保对LE采用特定的衬垫技术,提醒手术助手不要靠在LE上,并在整个病例中安排LE检查和重新定位,以预防和减轻隐性损伤。在此,我们报告了 2017 年 1 月至 2023 年 3 月期间所有接受 gGAS 手术(手术时间大于 300 分钟)的患者的临床定位相关结果和并发症。结果:共有 227 名患者接受了 310 例手术(156 例男性化 gGAS 手术,154 例女性化 gGAS 手术)。平均手术时间为 495.5 分钟+/-156.5 分钟(标清)(范围 300-1095 分钟)。共有 6/227 名(2.6%)患者(2 名男性化手术患者和 4 名女性化手术患者)在术后出现短暂的、自限性的 LE 疼痛。没有(0%)患者出现慢性神经损伤、压疮、横纹肌溶解症或隔室综合征等主要并发症。结论:我们的研究首次描述了一种可复制的技术,特别是整合了手术室团队和护理人员的技术,以预防 DL 期间的 LE 损伤。我们的研究结果表明,在长时间手术过程中,有可能实现 0% 到极少数的严重 LE 损伤发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Strategies to Prevent Lower-Extremity Positioning Injuries During Long-Duration Surgery in the Lithotomy Position: Our Techniques and Clinical Outcomes Following Genital Gender-Affirming Surgeries
Purpose: Lower-extremity (LE) injuries due to prolonged surgery duration in the dorsal lithotomy (DL) position are often morbid and can significantly affect the patient’s short and long-term quality of life. These include the development of lower extremity pressure ulcers, neuropathies, rhabdomyolysis, and compartment syndromes. As compared to other surgeries, this risk is increased in patients undergoing genital gender-affirming surgery (gGAS) due to the relatively long operative time of these surgeries related to their high complexity. Our study aimed to describe our technique for preventing LE injuries in the DL position, and to evaluate our positioning-related post-operative complications and rates. Materials and Methods: We describe our technique for positioning in the dorsal lithotomy position, with an emphasis on injury prevention. We ensure a specific padding technique of the LE, we alert surgical assistants to not lean/rest on the LE, and we schedule LE checks and repositioning throughout the case to prevent and mitigate occult injuries. Herein, we report our clinical positioning-related outcomes and complications among all patients undergoing gGAS procedures lasting >300 minutes between January 2017 to March 2023. Results: A total of 227 patients underwent 310 surgical procedures (156 masculinizing, 154 feminizing gGAS procedures). Mean operative time was 495.5 minutes+/-156.5 minutes (SD) (Range 300–1095 minutes). A total of 6/227 (2.6%) patients (2 masculinizing and 4 feminizing surgical patients) had transient, self-limited LE pain post-op. No (0%) patients had major complications including chronic nerve injury, pressure ulcers, rhabdomyolysis, or compartment syndrome. Conclusions: Our study is the first to describe a replicable technique, and specifically which integrates the OR team and nursing staff, to prevent LE injuries during DL. We show that it is possible to achieve a 0%-to-rare incidence of major LE injury during long-duration surgeries.
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