Automated cuff occlusion during foot surgery

NewsBot · Apr 12, 2011

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Automated Cuff Occlusion Pressure Effect on Quality of Operative Fields in Foot and Ankle Surgery: A Randomized Prospective Study.
Younger AS, Manzary M, Wing KJ, Stothers K.
Foot Ankle Int. 2011 Mar;32(3):239-243.

BACKGROUND: Limb occlusion pressure, which is present when blood flow ceases, has not had a practical method described for attainment. An automated tourniquet system was modified to set tourniquet pressure based on measurement of limb occlusion pressure (LOP). In this single surgeon randomized prospective study, the effectiveness of this system was assessed on patients undergoing foot and ankle surgery.

MATERIALS AND METHODS: Two hundred forty-four patients were randomized to the study group of automated pressure (n = 112) or to the control group (n = 132). The primary outcome measure was tourniquet pressure used for either group. Secondary measures included the time to set the pressure and number of patients failing LOP measurement. The tourniquet field was assessed intraoperatively and postoperatively in a blinded manner.

RESULTS: The tourniquet pressure was significantly lower in the study group at 198.5 ± 20.2 mmHg compared to 259.6 ± 4.4 in the control group (p < 0.001). The time to measure the LOP was 20 ± 6 seconds. Six patients failed to be measured. The quality of the surgical field was judged to be better in the study group based on all three methods of assessment.

CONCLUSION: LOP measurement was a practical way of setting tourniquet pressures for limb surgery. The automated pressure averages were lower than those routinely used by most surgeons for thigh tourniquets.
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Admin2 · Apr 12, 2011

Related thread:
Foot surgery tourniquet system based on systolic pressure

NewsBot · Mar 23, 2021

Retrospective review of complications following long tourniquet time in foot and ankle surgery
Rohit Gangadharan et al
J Clin Orthop Trauma. 2020 Dec 31

Background: Tourniquet use is ubiquitous in orthopaedic surgery to create a bloodless field and to facilitate safe surgery, however, we know of the potential complications that can occur as a result of prolonged tourniquet time. Experimental and clinical research has helped define the safe time limits but there is not much literature specific to foot and ankle surgery.

Methods: A retrospective review of the postoperative course of patients with prolonged tourniquet time (longer than 180 min) for foot and ankle procedures was done. Data related to the patient factors and the surgical procedure was collected. The length of stay, re-admissions and complications were the important indicators of the individual patient's recovery.

Results: Twenty patients were identified with longer than 180-min tourniquet times for complex foot and ankle procedures. The average uninterrupted tourniquet time was 191 min. Eight of the twenty procedures were revision surgeries. The average length of stay was 3 days and there were no re-admissions within 30 days. Eight patients (40%) had at least one recorded complication. The complications seen in this group were transient sensory loss, wound issues, superficial infection, ongoing pain and non-union.

Conclusions: This case series has not revealed any major systemic complications resulting from the prolonged tourniquet such as pulmonary embolism or renal dysfunction. Unlike past literature on knee procedures with extended tourniquet times, no major nerve palsies were seen in our patient group. Our understanding of the local and systemic effects of tourniquet is not complete and this study demonstrates that the complications do not necessarily increase in a linear fashion in relation to the tourniquet time.
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NewsBot · Aug 29, 2022

Extended Tourniquet Times and the Impact on Wound Healing in Foot Surgery
Callum Robertson et al
Clin Med Res. 2022 Aug 26

Objective: The aim of this study was to compare the effect of tourniquet time less than or in excess of 120 minutes on foot surgery wound healing.

Null hypothesis: A tourniquet time of over 120 minutes will not affect wound healing in foot surgery.

Design, setting, participants and method: A retrospective comparative cohort analysis was performed on 96 patients undergoing complex hindfoot surgery in a large central teaching hospital. Fifty-five patients receiving tourniquet pressure for >120 minutes and 41 receiving <120 minutes of tourniquet pressure were identified from electronic case records. The primary outcome was surgical wound healing. Secondary outcomes were discharge date and complication rate.

Results: There was no significant difference in reported time for wounds to heal in the <120-minute or >120-minute cohort. There were no other significant differences in secondary clinical outcomes and no significant variations in patient demographics.

Conclusion: This study suggests that tourniquet times from 2 to 3 hours in foot and ankle surgery with pressures up to 300 mmHg are not associated with a significant effect on wound healing.
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