Use of tourniquet in upper and lower extremity surgery

Leprosy Mailing List – March 1^st, 2010

Ref.: Use of tourniquet in upper and lower extremity surgery

From: James P. Wilton, Portsmouth , NH , USA

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Dear Dr. Noto,

I have read with great interest the ongoing commentaries regarding extremity tourniquet used in upper and lower extremity surgery. I can comfortably say after 25 years of lower extremity surgery both for reconstructive and peripheral neurological cases, that when a surgeon abides by the literature recommendations of releasing the tourniquet after 90 minutes for a 10 minute revascularization, that I have not seen any evidence of avascular necrosis or arterial compromise in the distal limb.

Studies have demonstrated that extremity hemostasis solely utilizing an Esmarch bandage can create internal pressure underneath the rubberized bandage well in excess of 300 mm of mercury. There is no way to clinically monitor the tissue pressure utilizing an Esmarch bandage as a tourniquet and this is not recommended or utilized either in the United States or South America where I perform surgery. Exsanguination of the limb with an Esmarch bandage prior to pressurization of a pneumatic limb tourniquet is preferred to help remove venous blood. This technique in no way creates vascular damage at the site of temporary application.

Advances in technology have allowed my surgical team to bring small digital tourniquets (Delphi Corporation) for our mission trips to South America . We utilized the use small digital tourniquet systems for major joint replacement surgery (TKR), pediatric orthopedic limb surgery and for both upper and lower extremity peripheral neurological surgery. With strict adherence to the above mentioned time frames for tourniquet application, we have not experienced any adverse vascular issues with these types of surgery.

Warmest regards,

Dr. James P. Wilton, FACFAS, FSPS
330 Borthwick Ave. Suite #112

Portsmouth , NH , 03801 -5102

USA

603-430-8505-Work

603-436-8381-Fax

603-502-8043-Cell

jpwilton(at)gmail.com