SLR - July 2022 - Esther Exantus, DPM
Reference: Gangadharan R, Roslee C, Kelsall N, Taylor H. Retrospective review of complications following long tourniquet time in foot and ankle surgery. J Clin Orthop Trauma. 2020 Dec 31;16:189-194Level of Evidence: Level IV
Scientific Literature Review
Reviewed By: Esther Exantus, DPM
Residency Program: University Hospital-Newark, NJ
Podiatric Relevance:
Pneumatic tourniquet use in foot and ankle surgery is quite common for the purpose of hemostasis and to create a visual field for the surgeon. Tourniquet use is not without its complications such as nerve palsy, swelling and long-term pain which is why safe tourniquet time is important, however most practices today are based on animal studies. In addition, majority of the clinical studies has been based on knee procedures. Today, podiatric surgeons are performing more extensive surgery that requires prolonged tourniquet use but there is lack of literature on the effects in using a tourniquet beyond three hours. The primary aim of this study was to see if there was a high incidence of complication in foot and ankle surgery with tourniquet time higher than three hours.
Methods:
A retrospective review was performed were procedures of the foot and ankle with uninterrupted tourniquet time greater than 180 minutes between 2011 and 2018 were identified. 20 patients were identified and patient specific details and procedure specific data such as surgery details, tourniquet time, length of stay within 30 days were collected. Inpatient records and clinical notes were also assessed for complications.
Results:
Twenty (20) patients were identified with uninterrupted tourniquet time exceeding 180 minutes; 13 males and seven females. All of the procedures were complex foot and ankle surgeries, which included total ankle replacement or primary fusion, eight of which were revision procedures. The average uninterrupted tourniquet time was 191 minutes and all patients had a tourniquet pressure set at 300mmhg. A total of eight patients had at least one recorded complication. Two patients had transient loss of sensation in the leg, one patient had blister formation around the wound with dehiscence in addition to a non-union of the medial column. One patient had a superficial infection and five patients had ongoing pain. None of these patients complained of tourniquet related pain in the thigh. In addition, there were no systematic complications reported such as pulmonary embolism or renal dysfunction.
Conclusion:
The authors concluded that the complication rates in this study are lower than the rates seen in previous studies with comparable tourniquet times. There were no major nerve palsies and early complications such as transient sensory loss and delayed wound healing all resolved. While this study demonstrated lower complication rates than previously studies, current recommendations as far as tourniquet use should be adhered as much as possible. In addition, the risk verses the benefit of extending the tourniquet time should be assessed by the surgeon for each case.