Use of the Tourniquet in Reconstructive Surgery in Patients with Previous Ipsilateral Lower Extremity Revascularization: Is it Safe? A Survey

Dučić, Ivica; Chang, Semoon; Dellon, A. Lee

doi:10.1055/s-2006-939964

Cited by 10 publications

(5 citation statements)

References 36 publications

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“…To date, none of my patients with neuropathy have required secondary vascular surgery intervention. If a patient has had a previous bypass arterial graft, our current recommendation is not to use a tourniquet during the surgery [22]. An occasional patient has developed a deep vein thrombosis.…”

Section: Post-op Managementmentioning

confidence: 99%

The Dellon Approach to Neurolysis in the Neuropathy Patient with Chronic Nerve Compression

Dellon

2008

Handchir Mikrochir plast Chir

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Impaired glucose tolerance creates a peripheral nervous system that is susceptible to chronic nerve compression. While it is accepted that surgical decompression of the median nerve at the wrist, for carpal tunnel syndrome, is appropriate in the diabetic, application of this concept to the lower extremity has not yet gained widespread recognition. Traditional electrodiagnostic studies demonstrate the presence of neuropathy, but usually are much less able to demonstrate superimposed nerve compression in the lower extremity in the presence of neuropathy. The clinician must rely upon the presence of a positive Hoffmann-Tinel sign to identify the patient with diabetic neuropathy and nerve compression. Combining sensory territories of common peroneal and tibial nerves gives a stocking pattern of sensory impairment. A positive Hoffmann-Tinel sign over the tibial nerve in the tarsal tunnel has a 90 % positive predictive value for the diabetic patient to recover sensibility in the foot after decompression of the four medial ankle tunnels. A meta-analysis of clinical studies that have decompressed the tibial nerve branches at the ankle in diabetics with neuropathy and tibial nerve compression demonstrate pain relief in 80 % of the patients from a mean of 8.5 on the VAS to 2.0, and demonstrate 80 % of the patients recover more than just protective sensation. With sensibility partially restored, ulceration and subsequent amputation can be prevented. Balance can recover, and with it, morbidity from falls/fracture can be prevented. Hospitalization for foot infection can be reduced. This review includes description of the surgical approaches to accomplish these outcomes.

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Section: Post-op Managementmentioning

confidence: 99%

The Dellon Approach to Neurolysis in the Neuropathy Patient with Chronic Nerve Compression

Dellon

2008

Handchir Mikrochir plast Chir

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“…19 20 Even with these results, the use of a tourniquet may not always be appropriate, such as for patients who have had prior revascularization procedures. 21…”

Section: Discussionmentioning

confidence: 99%

“…19,20 Even with these results, the use of a tourniquet may not always be appropriate, such as for patients who have had prior revascularization procedures. 21 Microsurgery techniques that utilize an extremity have likewise been employed following traumatic injuries and for oncologic reconstruction. A cross-sectional study concluded that approximately 70% of surveyed physicians would use an intraoperative tourniquet during lower limb reconstruction in the setting of trauma.…”

Section: Discussionmentioning

confidence: 99%

Tourniquet Use in Extremity-Based Microsurgery

Corbett

Rocks²,

et al. 2023

J Reconstr Microsurg

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Background The use of tourniquets and their role in extremity-based microsurgery has not been thoroughly investigated. The purpose of this study was to investigate tourniquet use and its associated outcomes and complications. Methods Approval from the Institutional Review Boards was granted at each site. A retrospective chart review was completed for patients who had undergone extremity-based microsurgery with the use of a tourniquet between 01/01/2018 and 02/01/2021 at two large academic institutions. Demographic characteristics, initial reasons for surgery, complications, and outcomes were recorded. Patients were separated into groups based on tourniquet-use during three operative segments: (1) flap elevation, (2) vessel harvest and (3) microvascular anastomosis. An internal comparison of complication rate was performed between cases for which a tourniquet was used for one operative segment to all cases in which it was not used for the same operative segment. Univariate and multivariate statistical analyses were performed to identify statistically significant results. Results A total of 99 patients (106 surgeries) were included in this study across sites. The mean age was 41.2 years and 67.7% of the patients were male. The most common reason for microsurgical reconstruction was a traumatic event (50.5%). The need for an additional unplanned surgery was the most common surgical complication (16%). 70% of procedures used a tourniquet for flap elevation. When these cases were compared to those that did not use a tourniquet for flap elevation, there was no difference in complication rates. 61% of procedures used a tourniquet for vessel harvest and 32% for anastomosis. Similarly, additional analyses identified no difference in complication rates when compared to procedures for which a tourniquet was not used for the intervention. Conclusions Based on these results, the authors encourage the use of tourniquets for extremity-based microsurgery to enable bloodless dissection without the concern of increased complication rates.

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“…These relative or absolute contraindications are in place because of the potential ischemic effect of tourniquet use on fragile or damaged soft tissues, or the potential for accentuating a hypercoagulable state. Other contraindications include patients with peripheral arterial bypass or vascular graft surgery secondary to the added risk of irreparable damage to the bypass or graft . Although these contraindications are generally accepted, and should be until strong evidence proves otherwise, the “American College of Foot and Ankle Surgeons Clinical Consensus Statement: Perioperative Management” reports there is insufficient literature to support them.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

Understanding and Optimizing Tourniquet Use During Extremity Surgery

Jensen¹,

Hicks²,

Labovitz³

2019

AORN Journal

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Tourniquet use during extremity surgery is commonplace and a relatively safe practice. The surgical team's knowledge of the patient history, proper assessment, and indications and contraindications for and risks of tourniquet use can prevent unwanted outcomes. Exploration of these critical areas reinforces perioperative nurses’ awareness and understanding of safe tourniquet use. Additionally, a review of the physiological effect of tourniquets on the skin, the body's response to local compression, the risk of vascular compromise, and the effect of the tourniquet on postoperative pain and swelling provides insight into AORN recommended practice guidelines. This article summarizes the indications and assessments for and risks of tourniquet use for patients during extremity surgery. An understanding of these topics can improve surgical outcomes and promote safe perioperative care.

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Use of the Tourniquet in Reconstructive Surgery in Patients with Previous Ipsilateral Lower Extremity Revascularization: Is it Safe? A Survey

Cited by 10 publications

References 36 publications

The Dellon Approach to Neurolysis in the Neuropathy Patient with Chronic Nerve Compression

The Dellon Approach to Neurolysis in the Neuropathy Patient with Chronic Nerve Compression

Tourniquet Use in Extremity-Based Microsurgery

Understanding and Optimizing Tourniquet Use During Extremity Surgery

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