An Innovative Method of Tourniquet Application in Proximal Lower Limb Surgery

Abstract

A novel method is presented by which a tourniquet can be applied just proximal to the greater trochanter, without interfering with asepsis. The distal migration of the tourniquet cuff is prevented by a Steinmann pin passed through the greater trochanter. This method has been tried in 20 cases of proximal lower limb surgery with great success. The use of a tourniquet in limb surgery is often required1. A common site of application of the tourniquet for lower limb surgery is at the junction of middle and upper third of the thigh. However, it is difficult to use such a tourniquet for extensive resection of malignant tumours around the knee joint where proximal limits of the incision may reach almost up to the subtrochanteric region. One can apply the tourniquet at the root of the limb just below and parallel to the inguinal ligament, but it may fail as a thigh is conical from proximal to distal and hence the tourniquet cuff or bandage slips downward, thus making it loose2. We have devised a method by which a tourniquet can be applied at the root of the thigh and can be maintained in the same position without any distal migration and loosening, thus making the thigh a bloodless field even up to the subtrochanteric level. We have used this technique for Van Nes rotation plasty and also for osteosynthesis of the middle third of the femur.