Lateral Oblique Position
The lateral oblique position (i.e., the three-quarters prone position)
is used primarily for exposure of the posterior fossa in neurosurgery but may be
used for other procedures on the back and upper neck. In this position, the torso
is rotated from supine to lateral ( Fig.
28-8
). The upper leg is brought forward and flexed slightly, and
Figure 28-8
Movement of the patient from the supine to the lateral
oblique position. (From Tew JM, Scodary DJ: Surgical positioning. In
Apuzzo MJ [ed]: Brain Surgery: Complication Avoidance and Management. New York,
Churchill Livingstone, 1993, p 1609.)
the lower leg is left straight. The head-holder pins may be placed before or after
the patient is turned. An axillary roll is placed under the chest to support the
weight of the body and to prevent the down axilla from being compressed. This is
done at an angle, slightly higher posteriorly and slightly more caudad anteriorly.
It should be possible to get part of a hand in the space between the chest wall
and the axilla. The lower shoulder is brought to the forward edge of the bed or
just slightly over it ( Fig. 38-9
).
The patient is then rotated to the three-quarters prone position so that the occipital
or lateral occipital skull is accessible to the surgeon. The upper arm is placed
downward
Figure 28-9
The lateral oblique (three-fourths prone) position.
The axillary roll is placed under the chest, and the lower shoulder is brought forward
to the edge of the bed or just slightly over the edge.
near the side wherever it falls comfortably. The upper shoulder must not be so high
that it interferes with surgical access.
For the park bench position, the lower arm is placed posteriorly
and parallel to the torso of a patient in the lateral oblique position. This position
places considerable weight on the head of the humerus and acromion, and these areas
should be padded carefully without excess bulk. Attention must be paid to the lower
breast to prevent pressure on the nipple and areola. Extreme flexion of the head
may compromise cervical spinal cord perfusion; quadriplegia can occur in the prone
position despite this precaution.[31]
There are several difficulties in placing a patient in the lateral
oblique position, and it is more difficult than lateral or prone positioning. Pressure
on the dependent axilla and its contents and breast tissue are appropriate concerns,
but there are no real guidelines for how much pressure is acceptable. Clinical experience
must ultimately be the guide.
