Tourniquet use in upper and lower extremity surgery

Leprosy Mailing List – March 1^st, 2010

Ref.: Tourniquet use in upper and lower extremity surgery

From: Antonio Salafia, Mumbai , India

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Dear Salvatore,

I would like to add my comments on the on-going discussion about tourniquet at its contraindications/side effects. As you know I am a trained hand-surgeon.

1.

In Legnano , Italy , where I trained under Prof. Morelli, we had an average of 40 major cases a day, in almost all cases a tourniquet was used.

2.

I have been following Prof. Morelli's teachings in all patients: leprosy and non-leprosy cases.
3.

I have operated a few hundred non leprosy patients (trauma, congenital) and more then 7000 leprosy cases.

In all the cases I have used the tourniquet, and so far, I have never had any compression/strangulation of nerves or any of the other side effects mentioned. I must add that when I operated on a nerve (be it the ulnar, the median or any other) I do not use a tourniquet except in a very few cases; most of the time there is no need; good hemostasis is all that it is required. Faulty technique, poor training are the reasons for these problems in most of the cases.

Dr. Antonio Salafia

Head of Dpt. Reconstructive Surgery

Vimala Dermatological Centre

Mumbai , India