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Pneumatic Tourniquets in Extremity Surgery

Dr. Wakai is Denis O’Sullivan Research Fellow, Department of Academic Surgery, Cork University Hospital, Cork, Ireland. Dr. Winter is Senior Resident, Department of General Surgery, Cork University Hospital. Dr. Street is Research Fellow, Academic Surgery Department, Cork University Hospital. Dr. Redmond is Professor of Surgery, University College Cork, and Consultant Surgeon, Cork University Hospital.

Reprint requests: Dr. Wakai, Department of Academic Surgery, Cork University Hospital, Cork, Ireland.

Pneumatic tourniquets maintain a relatively bloodless field during extremity surgery, minimize blood loss, aid identification of vital structures, and expedite the procedure. However, they may induce an ischemia-reperfusion injury with potentially harmful local and systemic consequences. Modern pneumatic tourniquets are designed with mechanisms to regulate and maintain pressure. Routine maintenance helps ensure that these systems are working properly. The complications of tourniquet use include postoperative swelling, delay of recovery of muscle power, compression neurapraxia, wound hematoma with the potential for infection, vascular injury, tissue necrosis, and compartment syndrome. Systemic complications can also occur. The incidence of complications can be minimized by use of wider tourniquets, careful preoperative patient evaluation, and adherence to accepted principles of tourniquet use.

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