Hilary A Bosman1, Andrew H N Robinson2. 1. Addenbrooke's Hospital, Cambridge CB2 2QQ, UK. Electronic address: hilary.bosman@nhs.net. 2. Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
Abstract
BACKGROUND: The majority of foot and ankle surgery is carried out in a bloodless field achieved by the use of a pneumatic tourniquet. The risks of tourniquet use may be divided into those resulting from direct mechanical pressure from the cuff and those secondary to prolonged limb ischaemia. Current peri-operative guidelines advise the use of padding beneath the cuff, in particular to reduce skin complication. OBJECTIVES: To assess the complication rate of tourniquet use when the cuff is applied directly to the skin. METHOD: Patients undergoing foot and ankle surgery under tourniquet control without use of padding were assessed pre and post operatively for soft tissue complication, neurological deficit and post-tourniquet syndrome. RESULTS: We recorded findings for 97 patients, 47 thigh and 50 ankle tourniquets. We found a complication rate of 0%. There were no cases of skin blistering, abrasion, bruising, laceration or burn. CONCLUSIONS: These findings are contrary to published RCTs supporting the use of padding. Our study demonstrates the safe use of pneumatic tourniquets without padding in foot and ankle surgery.
BACKGROUND: The majority of foot and ankle surgery is carried out in a bloodless field achieved by the use of a pneumatic tourniquet. The risks of tourniquet use may be divided into those resulting from direct mechanical pressure from the cuff and those secondary to prolonged limb ischaemia. Current peri-operative guidelines advise the use of padding beneath the cuff, in particular to reduce skin complication. OBJECTIVES: To assess the complication rate of tourniquet use when the cuff is applied directly to the skin. METHOD:Patients undergoing foot and ankle surgery under tourniquet control without use of padding were assessed pre and post operatively for soft tissue complication, neurological deficit and post-tourniquet syndrome. RESULTS: We recorded findings for 97 patients, 47 thigh and 50 ankle tourniquets. We found a complication rate of 0%. There were no cases of skin blistering, abrasion, bruising, laceration or burn. CONCLUSIONS: These findings are contrary to published RCTs supporting the use of padding. Our study demonstrates the safe use of pneumatic tourniquets without padding in foot and ankle surgery.