Professional Documents
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Peter C A Kam
Velcro
surface
Abstract
Rubberized
surface of
tourniquet
Dual cuff
valve
Pressure
monitor
Figure 1
Nerve injuries associated with tourniquets range from paraesthesia to complete paralysis. In the UK, the incidence of paralysis associated with the pneumatic tourniquet per year is 1 per
11,000 population in the upper limb, and 1 per 250,000 population in the lower limb. The peripheral nerve most frequently
injured is the radial nerve, followed by the ulnar, median and
sciatic nerves. The use of an esmarch bandage tourniquet to
exsanguinate the limb is not recommended because it generates pressures >1000 mmHg (133.3 kPa), resulting in a higher
incidence of nerve injury. Maximal exsanguination can be
achieved by elevation of the arm (90) and leg (45) for five
minutes.
Direct pressure beneath the cuff and shearing pressures at the
edge of the cuff are the major causes of nerve injury. Axonal
degeneration results from intraneural microvascular abnormal
ities and oedema formation and can lead to neuropraxia (axonal
dysfunction). Axial compression causing damage at the nodes
of Ranvier may occur. Prolonged neurological deficits are due to
axonal disruption.
Local injuries
Localized complications result from compression to underlying
skin, nerve, muscle and blood vessels beneath the cuff or tissue
ischaemia distal to the tourniquet.
Skin injury: erythema of the skin is common, but of little consequence. Bullous lesions after prolonged tourniquet inflation
(and friction burns caused by movement of poorly applied tourniquets) may occur.
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up to a month to resolve. The combined effect of muscle ischaemia, oedema and microvascular congestion commonly leads
to post-tourniquet syndrome, characterized by stiffness, pallor,
weakness without paralysis and subjective numbness of the
extremity. This post-anoxic oedema, together with reperfusion
hyperaemia and haematoma formation, can result in a compartment syndrome.
Vascular injury: mechanical pressure from a tourniquet in
surgery of the lower limb can cause arterial injury in patients
with peripheral vascular disease via fracture of an atheromatous
plaque. The lack of blood flow due to the tourniquet may cause
thrombosis in atherosclerotic vessels. Tourniquets are contraindicated in patients with absent distal pulses, poor capillary return,
a calcified femoro-popliteal system or who have had previous
vascular surgery on the involved limb.
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Antibiotic administration
Prophylactic antibiotics for surgery should be given intra
venously at least five minutes before tourniquet inflation to
ensure adequate penetration of tissues.
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