Surgical tourniquets in orthopaedics

Journal of Bone and Joint Surgery

Volumn 91, Issue 12, 2009, Pages 2958-2967

  Noordin, Shahryar ^a   McEwen, James A ^b   Kragh, John F ^c   Eisen, Andrew ^b   Masri, Bassam A ^b  

^a AGA KHAN UNIVERSITY   (Pakistan)

^b UNIVERSITY OF BRITISH COLUMBIA   (Canada)

^c US ARMY INSTITUTE OF SURGICAL RESEARCH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

LIMB OCCLUSION PRESSURE; NERVE INJURY; ORTHOPEDICS; PATHOGENESIS; PATIENT SAFETY; PRESSURE; PRESSURE GRADIENT; PRIORITY JOURNAL; RELIABILITY; REVIEW; SURGICAL TECHNIQUE; THERAPY EFFECT; TOURNIQUET; EQUIPMENT DESIGN; HISTORY; HUMAN; INSTRUMENTATION; LIMB; MILITARY MEDICINE; NERVOUS SYSTEM INJURY; ORTHOPEDIC SURGERY; TIME; VASCULARIZATION;

EQUIPMENT DESIGN; EXTREMITIES; HISTORY, 19TH CENTURY; HISTORY, 20TH CENTURY; HISTORY, 21ST CENTURY; HISTORY, ANCIENT; HUMANS; MILITARY MEDICINE; ORTHOPEDIC PROCEDURES; PRESSURE; TIME FACTORS; TOURNIQUETS; TRAUMA, NERVOUS SYSTEM;

EID: 73349105595     PISSN: 00219355     EISSN: 15351386     Source Type: Journal    
DOI: 10.2106/JBJS.I.00634     Document Type: Review

References (58)

1. Klenerman L. The tourniquet in surgery. J Bone Joint Surg Br. 1962;44:937-43.
2. Lister JB. Collected papers. Vol 1. Oxford: Clarendon Press; 1909. p 176.
3. von Esmarch F. First aid to the injured: six ambulance lectures. HRH Princess Christian, translator. 6th ed. London: Smith, Elder and Co; 1898.
4. Cushing H. Pneumatic tourniquets: with special reference to their use in craniotomies. Med. News. 1904;84:557.
5. Murphy CG, Winter DC, Bouchier-Hayes DJ. Tourniquet injuries: pathogenesis and modalities for attenuation. Acta Orthop Belg. 2005;71:635-45.
6. McEwen J, Casey V. Measurement of hazardous pressure levels and gradients produced on human limbs by non-pneumatic tourniquets. In: Proceedings of the 32nd Conference of the Canadian Medical and Biological Engineering Society 2009. Calgary, Canada; 2009 May 20-22. p 1-4.
7. McEwen JA. Complications of and improvements in pneumatic tourniquets used in surgery. Med Instrum. 1981;15:253-7.
8. Elements of a modern tourniquet system. http://www.tourniquets.org/ tourniquet-technology.php
9. Wakai A, Winter DC, Street JT, Redmond PH. Pneumatic tourniquets in extremity surgery. J Am Acad Orthop Surg. 2001;9:345-51.
10. McGraw RW, McEwen JA. The tourniquet. In: McFarlane RM, editor. Unsatisfactory results in hand surgery. New York: Churchill Livingstone; 1987. p 5-13.
11. Weingarden SI, Louis DL, Waylonis GW. Electromyographic changes in post-meniscectomy patients. Role of the pneumatic tourniquet. JAMA. 1979;241: 1248-50.
12. Dobner JJ, Nitz AJ. Postmeniscectomy tourniquet palsy and functional sequelae. Am J Sports Med. 1982;10:211-4.
13. Nitz AJ, Dobner JJ. Upper extremity tourniquet effects in carpal tunnel release. J Hand Surg Am. 1989;14:499-504.
14. Mohler LR, Pedowitz RA, Myers RR, Ohara WM, Lopez MA, Gershuni DH. Intermittent reperfusion fails to prevent posttourniquet neurapraxia. J Hand Surg Am. 1999;24:687-93.
15. Odinsson A, Finsen V. Tourniquet use and its complications in Norway. J Bone Joint Surg Br. 2006;88:1090-2. (Pubitemid 44241209)
16. Middleton RW, Varian JP. Tourniquet paralysis. Aust N Z J Surg. 1974;44: 124-8.
17. Ochoa J, Danta G, Fowler TJ, Gilliatt RW. Nature of the nerve lesion caused by a pneumatic tourniquet. Nature. 1971;233:265-6.
18. Ochoa J, Fowler TJ, Gilliatt RW. Anatomical changes in peripheral nerves compressed by a pneumatic tourniquet. J Anat. 1972;113 (pt 3):433-55.
19. Gilliatt RW, Ochoa J, Rudge P, Neary D. The cause of nerve damage in acute compression. Trans Am Neurol Assoc. 1974;99:71-4.
20. McLaren AC, Rorabeck CH. The pressure distribution under tourniquets. J Bone Joint Surg Am. 1985;67:433-8.
21. Shaw JA, Murray DG. The relationship between tourniquet pressure and underlying soft-tissue pressure in the thigh. J Bone Joint Surg Am. 1982;64:1148-52.
22. Graham B, Breault MJ, McEwen JA, McGraw RW. Perineural pressures under the pneumatic tourniquet in the upper extremity. J Hand Surg Br. 1992;17: 262-6.
23. Graham B, Breault MJ, McEwen JA, McGraw RW. Occlusion of arterial flow in the extremities at subsystolic pressures through the use of wide tourniquet cuffs. Clin Orthop Relat Res. 1993;286:257-61.
24. Pedowitz RA, Gershuni DH, Botte MJ, Kuiper S, Rydevik BL, Hargens AR. The use of lower tourniquet inflation pressures in extremity surgery facilitated by curved and wide tourniquets and an integrated cuff inflation system. Clin Orthop Relat Res. 1993;287:237-44.
25. McEwen JA, Inkpen K, Younger A. Thigh tourniquet safety. Surg Technol. 2002;24:8-18.
26. Younger AS, McEwen JA, Inkpen K. Wide contoured thigh cuffs and automated limb occlusion measurement allow lower tourniquet pressures. Clin Orthop Relat Res. 2004;428:286-93. (Pubitemid 39506185)
27. McEwen JA, Kelly DL, Jardanowski T, Inkpen K. Tourniquet safety in lower leg applications. Orthop Nurs. 2002;21:55-62.
28. Tuncali B, Karci A, Tuncali BE, Mavioglu O, Ozkan M, Bacakoglu AK, Baydur H, Ekin A, Elar Z. A new method for estimating arterial occlusion pressure in optimizing pneumatic tourniquet inflation pressure. Anesth Analg. 2006;102:1752-7.
29. Reilly CW, McEwen JA, Leveille L, Perdios A, Mulpuri K. Minimizing tourniquet pressure in pediatric anterior cruciate ligament reconstructive surgery: a blinded, prospective randomized controlled trial. J Pediatr Orthop. 2009;29: 275-80.
30. AORN, recommended practices for use of the pneumatic tourniquet. In: Perioperative standards and recommended practices. 2009 ed. Denver, CO: AORN Inc; 2009. p 373-85.
31. Majno G. The healing hand: man and wound in the ancient world. Cambridge, MA: Harvard University Press; 1975. p 278-9, 403-5.
32. Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg. 2009;249:1-7.
33. Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64(2 Suppl):S38-50.
34. NAEMT. PHTLS prehospital trauma life support: military version. 6th ed. St. Louis: Mosby; 2006. p 501-19.
35. Hodgetts TJ, Mahoney PF. The military tourniquet: a response. J R Army Med Corps. 2007;153:12-5.
36. Boiko M, Roffman M. Evaluation of a novel tourniquet device for bloodless surgery of the hand. J Hand Surg Br. 2004;29:185-7.
37. Orbay H, Unlü RE, Kerem M, Sensöz O. Clinical experiences with a new tourniquet device. Ann Plast Surg. 2006;56:618-21. (Pubitemid 43833036)
38. Colville J, Small JO. Exsanguination of the upper limb in hand surgery comparison of four methods. J Hand Surg Br. 1986;11:469-70.
39. Klenerman L. The tourniquet manual: principles and practice. London: Springer; 2003.
40. Olivecrona C, Tidermark J, Hamberg P, Ponzer S, Cederfjäll C. Skin protection underneath the pneumatic tourniquet during total knee arthroplasty: a randomized controlled trial of 92 patients. Acta Orthop. 2006;77:519-23.
41. Tredwell SJ, Wilmink M, Inkpen K, McEwen JA. Pediatric tourniquets: analysis of cuff and limb interface, current practice, and guidelines for use. J Pediatr Orthop. 2001;21:671-6.
42. McEwen JA, Inkpen K. Tourniquet safety: preventing skin injuries. Surg Technol. 2002;24:6-15.
43. Flatt AE. Tourniquet time in hand surgery. Arch Surg. 1972;104:190-2.
44. Klenerman L. Tourniquet time-how long? Hand. 1980;12:231-4.
45. Bruner JM. Time, pressure, and temperature factors in the safe use of the tourniquet. Hand. 1970;2:39-42.
46. Ostman B, Michaelsson K, Rahme H, Hillered L. Tourniquet-induced ischemia and reperfusion in human skeletal muscle. Clin Orthop Relat Res. 2004;418: 260-5. (Pubitemid 38140458)
47. Wilgis EF. Observations on the effects of tourniquet ischemia. J Bone Joint Surg Am. 1971;53:1343-6.
48. Klenerman L, Biswas M, Hulands GH, Rhodes AM. Systemic and local effects of the application of a tourniquet. J Bone Joint Surg Br. 1980;62:385-8.
49. Parmet JL, Berman AT, Horrow JC, Harding S, Rosenberg H. Thromboembolism coincident with tourniquet deflation during total knee arthroplasty. Lancet. 1993;341:1057-8.
50. Jarrett PM, Ritchie IK, Albadran L, Glen SK, Bridges AB, Ely M. Do thigh tourniquets contribute to the formation of intra-operative venous emboli? Acta Orthop Belg. 2004;70:253-9.
51. Christodoulou AG, Ploumis AL, Terzidis IP, Chantzidis P, Metsovitis SR, Nikiforos DG. The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement. Knee. 2004;11:313-7. (Pubitemid 38903243)
52. Rama KR, Apsingi S, Poovali S, Jetti A. Timing of tourniquet release in knee arthroplasty. Meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2007;89:699-705.
53. McEwen JA, McGraw RW. An adaptive tourniquet for improved safety in surgery. IEEE Trans Biomed Eng. 1982;29:122-8.
54. Ishii Y, Noguchi H, Matsuda Y, Takeda M, Higashihara T. A new tourniquet system that determines pressures in synchrony with systolic blood pressure. Arch Orthop Trauma Surg. 2008;128:297-300.
55. Kuwabara S. Carpal tunnel syndrome: demyelinative or ischemic conduction block? Clin Neurophysiol. 2009;120:223-4.
56. Ikemoto T, Tani T, Taniguchi S, Ikeuchi M, Kimura J. Effects of experimental focal compression on excitability of human median motor axons. Clin Neurophysiol. 2009;120:342-7.
57. UnitedStatesDefenseAdvancedResearch Projects Agency (DARPA).DeepBleeder Acoustic Coagulation (DBAC). http://www.darpa.mil/STO/smallunitops/dbac.html.
58. Science and Society Picture Library. http://www.sciencemuseum.org.uk/ hommedia.ashx?id=9066&size=Large