| Abstract | The tourniquet is routinely used in daily practice for upper and lower limb orthopedic surgery, in order to obtain a bloodless surgical field and thus, to allow a better visualization for the surgeon. Tourniquet use is associated to several local and systemic complications which can be disabling or even lethal, including pulmonary embolism, reperfusion injury, and permanent neurological damage. Several conditions can be considered as contraindications for the use of tourniquet, even though their classification either in relative or absolute contraindication group remains controversial. Those relative or absolute contraindications include deep vein thrombosis, atherosclerosis, vascular fragility (diabete mellitus, arteriopathies, vasculitis, calcified vessels, arterioveinous fistula, collagen vascular diseases, vascular prosthesis), cutaneous fragility, bone malunion, cerebral hypertension and cerebral trauma, sickle cell disease, rhumatoid arthritis, the presence of a local tumour or abcess, and cardiac or respiratory deficiency. The limb exsanguination should be performed by a simple elevation of the operated limb for 5 minutes. The tourniquet should be placed as distal as possible, and inflated to a pressure 50 to 75 mmHg higher than the arterial occluding pressure, which should be calculated according to the Graham’s formula. Reperfusion periods of 10 minutes after every hour of ischemia are beneficial and thus can be implemented, but such reperfusion periods should be avoided if the ischemia lasted longer than 2 hours because they canbecome a factor aggravating the complications. Early after deflation, in the post-surgery minutes and hours, the neurological and vascular status of the operated limb should be carefully monitored in order to detect any potential complication as early as possible. The use of tourniquet is not harmless to the patient and thus should be objectively justified by the needs of the patient and only aimed at his own benefit. |
