Leprosy
Mailing List – March 1st, 2010
Ref.: Use
of tourniquet in upper and lower extremity surgery
From: James
P. Wilton,
Portsmouth
,
NH
,
USA
Dear
Dr. Noto,
I
have read with great interest the ongoing commentaries regarding
extremity tourniquet used in upper and lower extremity surgery.
I can comfortably say after 25 years of lower extremity surgery both
for reconstructive and peripheral neurological cases, that when a
surgeon abides by the literature recommendations of releasing the
tourniquet after 90 minutes for a 10 minute revascularization, that I
have not seen any evidence of avascular necrosis or arterial
compromise in the distal limb.
Studies
have demonstrated that extremity hemostasis solely utilizing an
Esmarch bandage can create internal pressure underneath the rubberized
bandage well in excess of
300 mm
of mercury. There is no way to clinically monitor the tissue
pressure utilizing an Esmarch bandage as a tourniquet and this is not
recommended or utilized either in the United States or South America
where I perform surgery. Exsanguination of the limb with an
Esmarch bandage prior to pressurization of a pneumatic limb tourniquet
is preferred to help remove venous blood. This
technique in no way creates vascular damage at the site of temporary
application.
Advances
in technology have allowed my surgical team to bring small
digital tourniquets (Delphi Corporation) for our mission trips to
South America
. We utilized the use
small digital tourniquet systems for major joint replacement surgery (TKR),
pediatric orthopedic limb surgery and for both upper and lower
extremity peripheral neurological surgery. With
strict adherence to the above mentioned time frames for tourniquet
application, we have not experienced any adverse vascular issues with
these types of surgery.
Warmest
regards,
Dr.
James P. Wilton, FACFAS, FSPS
330 Borthwick Ave. Suite #112
Portsmouth
,
NH
,
03801
-5102
USA
603-430-8505-Work
603-436-8381-Fax
603-502-8043-Cell
jpwilton(at)gmail.com
