The authors declare that they have no competing interests.
KER was responsible for conception and design, analysis and interpretation of data and drafting the manuscript. BM participated in the design of the study and was responsible for clinical management of the patients and for acquisition of data. GSM was involved in drafting the manuscript and interpretation of data. UM has been involved in critical revision of the manuscript with regard to important intellectual content. JDR has been involved in critical revision of the manuscript. MB participated in the design of the study and performed the statistical analysis. FB provided general supervision of the research group and was involved in critical revision of the manuscript. All authors read and approved the final manuscript. This paper contains data from an as yet unpublished thesis by the author BM.
Compression of the tissue beneath tourniquets used in limb surgery is associated with varying degrees of soft tissue damage. The interaction between fluids and applied pressure seems to play an important role in the appearance of skin lesions. The extent of the transfer of force between the tourniquet and the skin, however, has yet to be studied. The aim of the present study was to quantify in-vivo the transfer of pressure between a tourniquet and the skin of the thigh.
Pressure under the tourniquet was measured using sensors in 25 consecutive patients over the course of elective surgical procedures. Linear mixed modeling was used to assess the homogeneity of the distribution of pressure around the circumference of the limb, variation in pressure values over time, and the influence of limb circumference and the Body-Mass-Index (BMI) on pressure transfer.
Mean pressure on the skin was significantly lower than the inner pressure of the cuff (5.95%, 20.5 ± 9.36 mmHg, p < 0.01). There was a discrete, but significant (p < 0.001) increase in pressure within the first twenty minutes after inflation. Sensors located in the area of overlap of the cuff registered significantly higher pressure values (p < 0.01). BMI and leg circumference had no influence on the transfer of pressure to the surface of the skin (p = 0.88 and p = 0.51).
Pressure transfer around the circumference of the limb was distributed inhomogeneously. The measurement series revealed a global pressure drop compared to the initial pressure of the cuff. No relationship could be demonstrated between the pressure transferred to the skin and the BMI or limb circumference.
Deloughry JL, Griffiths R. Arterial tourniquets. Continuing Education in Anaesthesia, Critical Care & Pain Volume. 2009;9(2)
Sapega AA, Heppenstall RB, Chance B, Park YS, Sokolow D. Optimizing tourniquet application and release times in extremity surgery. A biochemical and ultrastructural study. J Bone Joint Surg Am. 1985;67(2):303–14. Epub 1985/02/01. PubMed
Murphy CG, Winter DC, Bouchier-Hayes DJ. Tourniquet injuries: pathogenesis and modalities for attenuation. Acta Orthop Belg. 2005;71(6):635–45. Epub 2006/02/08. PubMed
Koval KJ, Egol KA, Polatsch DB, Baskies MA, Homman JP, Hiebert RN. Tape blisters following hip surgery. A prospective, randomized study of two types of tape. J Bone Joint Surg Am. 2003;85-A(10):1884–7. Epub 2003/10/18. PubMed
Newman RJ, Muirhead A. A safe and effective low pressure tourniquet. A prospective evaluation. J Bone Joint Surg Br. 1986;68(4):625–8. Epub 1986/08/01. PubMed
R Development Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2011. ISBN 3-900051-07-0, URL http://www.R-project.org/.
McLaren AC, Rorabeck CH. The pressure distribution under tourniquets. J Bone Joint Surg Am. 1985;67(3):433–8. Epub 1985/03/01. PubMed
Shaw JA, Murray DG. The relationship between tourniquet pressure and underlying soft-tissue pressure in the thigh. J Bone Joint Surg Am. 1982;64(8):1148–52. Epub 1982/10/01. PubMed
- In-vivo analysis of epicutaneous pressure distribution beneath a femoral tourniquet – an observational study
Klaus Edgar Roth
Gerrit Steffen Maier
- BioMed Central
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