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Warner C, Peach C, Davies R. Widening Access: Sterile Tourniquets for Surgery to the Distal Humerus. Cureus 2023; 15:e46148. [PMID: 37900452 PMCID: PMC10613037 DOI: 10.7759/cureus.46148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose of the study The use of tourniquets during surgery of the distal humerus can improve visibility and reduce surgical time. However, the available operating field can be limited due to the size and placement of the tourniquet. This proof-of-concept study aimed to determine if sterile tourniquets can provide a wider surgical field compared to non-sterile tourniquets for procedures around the distal humerus. Methods Volunteers (n = 5) were positioned to simulate access to the distal humerus. The distance from the posterior corner of the acromion to the tip of the olecranon was measured. Participants were draped according to the standard protocol for the use of a non-sterile or sterile tourniquet for distal humerus and humeral shaft fractures. Two non-sterile pneumatic tourniquets (standard and narrow) and two sterile tourniquets (pneumatic and elastic exsanguination) were tested. The surgical field was measured from the sterile drape or tourniquet proximally to the tip of the olecranon. A one-way repeated measures ANOVA was conducted to examine the effect of each tourniquet on the surgical field. Results The sterile elastic exsanguination tourniquet had the largest available field with a mean of 24.4 cm (71% of arm available for incision after application), followed by the sterile pneumatic tourniquet of 20.0 cm (58%), narrow non-sterile pneumatic of 19.2 cm (55%), and standard non-sterile pneumatic of 17.0 cm (49%). Repeated measures ANOVA determined that mean surgical field length is statistically significant between tourniquet devices (F (1.729, 6.914) = 21.783, p = .001). The surgical field length was statistically significantly increased from a non-sterile standard tourniquet to a sterile elastic tourniquet (7.4 (95% CI, 2.9-11.9) cm, p = .008) but not the other two tourniquet devices tested. Conclusion The use of certain types of sterile tourniquets can provide a wider surgical field compared to non-sterile tourniquets for procedures around the distal humerus, specifically the sterile elastic exsanguination tourniquet providing a statistically significant mean gain of 7.4 cm from the non-sterile tourniquets. These findings suggest that the use of sterile tourniquets should be considered more frequently in surgery of the distal humerus, and a sterile exsanguinating tourniquet could be considered for midshaft humeral fractures, facilitating safer exposure of the radial nerve and reduced blood loss.
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Affiliation(s)
- Christian Warner
- Trauma and Orthopaedics, Manchester Shoulder and Elbow Unit, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, GBR
| | - Christopher Peach
- Trauma and Orthopaedics, Manchester Shoulder and Elbow Unit, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, GBR
| | - Ronnie Davies
- Trauma and Orthopaedics, Manchester Shoulder and Elbow Unit, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, GBR
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Bae K, Kim G, Aldosari AM, Gim Y, Kwak YH. Sterile Silicone Ring Tourniquets in Limb Surgery: A Prospective Clinical Trial in Pediatric Patients Undergoing Orthopedic Surgery. J Pers Med 2023; 13:979. [PMID: 37373968 DOI: 10.3390/jpm13060979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Sterile silicone ring tourniquets (SSRTs) reduce intraoperative bleeding and provide a wide surgical view. Moreover, they reduce the risk of contamination and are cheaper than conventional pneumatic tourniquets. Our study describes the perioperative outcomes of sterile silicone ring tourniquet placement in pediatric patients undergoing orthopedic surgery. We prospectively recruited 27 pediatric patients aged < 18 years who underwent 30 orthopedic surgeries between March and September 2021. Following complete surgical draping, all operations were initiated by placing SSRTs. We investigated the demographic and clinical characteristics of these patients, details of the tourniquet used, and intra- and postoperative outcomes of tourniquet placement. Owing to the narrowness of tourniquet bands and tourniquet placement at the proximal ends of the extremities, wide surgical fields were achieved, without limiting joint range of motion. Bleeding control was effective. Tourniquets were applied and removed rapidly and safely, regardless of limb circumference. None of the patients experienced postoperative pain, paresthesia, skin problems at the application site, surgical site infections, ischemic problems, or deep vein thrombosis. SSRTs effectively reduced intraoperative blood loss and facilitated wide operative fields in pediatric patients with various limb sizes. These tourniquets allow quick, safe, and effective orthopedic surgery for pediatric patients.
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Affiliation(s)
- Kunhyung Bae
- Department of Orthopedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Gisu Kim
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Amaal M Aldosari
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
- Department of Orthopaedic Surgery, Al Noor Specialist Hospital, Makkah 24242, Saudi Arabia
| | - Yeonji Gim
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul 03722, Republic of Korea
| | - Yoon Hae Kwak
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Silicone ring tourniquet versus pneumatic cuff tourniquet in total knee arthroplasty surgery: A randomised comparative study. J Orthop 2018; 15:545-548. [PMID: 29881190 DOI: 10.1016/j.jor.2018.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/06/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction The aim of the present study was to compare a silicone ring tourniquet (SRT) and a classic pneumatic cuff tourniquet (PT) in patients undergoing total knee replacement. We have compared the impact on the glycolytic activity caused by the ischaemia applied to the limb during the surgery. Material and methods 140 patients that underwent total knee arthroplasty (TKA) were randomised in two groups. Serum lactate determination was made by reactive strips of enzymatic-amperometric detection, 5 min before tourniquet application and 5 min after tourniquet removal. Results The mean tourniquet time was similar for both groups (p 0.13). Postoperative serum lactate levels were higher with statistical significance than the preoperative levels and with a positive Pearson´s correlation in the overall cases. The postoperative serum lactate levels where higher in the PT group (4.097 ± 2.248 mmol/L) than the SRT group (3.499 ± 1.566 mmol/L). There was no significant difference (p 0.07) to be able to affirm that there was a difference of the anaerobic metabolism according to the tourniquet system used. Discussion Ischaemia applied to the lower extremity during knee replacement surgery can produce tissue injury. Serum lactate determination allows comparison of the ischaemic changes during TKA surgery caused by two different tourniquet systems. Conclusions SRT may be not disadvantageous compared to the classic PT from the impact on the glycolytic activity caused by the ischaemia.Level of evidence II.
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Disparate postoperative results in the first and second knees on simultaneous bilateral total knee arthroplasty. J Arthroplasty 2014; 29:2331-6. [PMID: 25131798 DOI: 10.1016/j.arth.2014.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/25/2014] [Accepted: 07/19/2014] [Indexed: 02/01/2023] Open
Abstract
We hypothesized that the circumstances of the two consecutive operations of a simultaneous bilateral total knee arthroplasty (TKA) are different, and could lead to different outcomes of overlapping bilateral TKAs. Both knees of 420 subjects were evaluated in the current study. In the second TKA, there were more incidence rates of outlier in mechanical femoro-tibial angle (16.2% vs. 9.0%), more blood loss (735 vs. 656 mL), and longer operation time (61, 58 minutes respectively), as compared to the first TKA, while no significant differences in clinical outcomes. In conclusion, there were no significant differences in the clinical outcomes even though few distinct outcomes due to different circumstances of the surgery. Awareness of these findings can help the continued success of bilateral TKA in an increasing patient population.
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Demirkale I, Tecimel O, Sesen H, Kilicarslan K, Altay M, Dogan M. Nondrainage decreases blood transfusion need and infection rate in bilateral total knee arthroplasty. J Arthroplasty 2014; 29:993-7. [PMID: 24275263 DOI: 10.1016/j.arth.2013.10.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/09/2013] [Accepted: 10/23/2013] [Indexed: 02/01/2023] Open
Abstract
This retrospective study enrolled 526 patients undergoing bilateral total knee arthroplasties at our institution. In nondrainage group (Group 1) of 255 patients (510 knees), a disposable elastic sterile exsanguination tourniquet (HemaClear), wound closure in layers and Jones Bandage, without pre-tourniquet removal hemostasis or Hemovac drain were used. In drainage group (Group 2) of 227 patients (454 knees), pneumatic tourniquet, post-deflation hemostasis, a Hemovac drain and Jones bandage were used. The maximal drop in hemoglobin was significantly greater in Group 2 than Group 1 (P < 0.001). Also infection rate was significantly lower in Group 1 (P = 0.017). The use of sterile tourniquet removed after wound closure without Hemovac drain decreases blood transfusion need, infection rate, tourniquet related pain and postoperative complications.
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Affiliation(s)
- Ismail Demirkale
- Departments of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ankara, Turkey
| | - Osman Tecimel
- Departments of Orthopaedics and Traumatology, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Hakan Sesen
- Departments of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ankara, Turkey
| | - Kasim Kilicarslan
- Departments of Orthopaedics and Traumatology, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Murat Altay
- Departments of Orthopaedics and Traumatology, Kecioren Education and Research Hospital, Ankara, Turkey
| | - Metin Dogan
- Departments of Orthopaedics and Traumatology, Yildirim Beyazit University, School of Medicine, Ankara, Turkey
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Wang S. Pneumatic Tourniquet for Surgical Procedures of Hemodialysis Vascular Access. Semin Dial 2014; 28:81-9. [DOI: 10.1111/sdi.12242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shouwen Wang
- AKDHC Surgery Center; Arizona Kidney Disease and Hypertension Center; Phoenix Arizona
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Drosos GI, Ververidis A, Stavropoulos NI, Mavropoulos R, Tripsianis G, Kazakos K. Silicone ring tourniquet versus pneumatic cuff tourniquet in carpal tunnel release: a randomized comparative study. J Orthop Traumatol 2013; 14:131-5. [PMID: 23361654 PMCID: PMC3667358 DOI: 10.1007/s10195-012-0223-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 12/20/2012] [Indexed: 11/29/2022] Open
Abstract
Background The aim of the present study was to compare the pain levels resulting from the use of a silicone ring tourniquet (SRT) to those resulting from the use of a classic pneumatic cuff tourniquet (PT) in patients undergoing carpal tunnel release under local anesthesia. Materials and methods Fifty patients that underwent carpal tunnel release under local anesthesia were randomized using the technique of stratified randomization by minimization. A forearm tourniquet was applied: a standard PT was used in 25 patients, and an SRT was used in the other 25 patients (the model of SRT used was selected according to the standard systolic blood pressure). Patient demographics and complications were recorded. Pain levels were assessed with the visual analogue scale and were recorded (a) just after tourniquet application, (b) 5 min after tourniquet application, and (c) just before tourniquet removal. Results There was no statistical significant difference in patient demographics between the two groups. The mean tourniquet time was similar for both groups (p = 1.000). The difference between the mean final pain level and the mean initial pain level was statistically significant for the SRT group (p = 0.010) and highly statistically significant for the PT group (p < 0.001). The mean final pain level for the PT group was higher than that for the SRT group (p = 0.043). Conclusions According to the findings of this study, in patients who underwent carpal tunnel release under local anesthesia, the pain levels at the end of the operation and those just before the removal of the tourniquet were higher in the PT group than in the SRT group of patients.
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Affiliation(s)
- G I Drosos
- Department of Orthopaedic Surgery, Medical School, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
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Smith OJ, Heasley R, Eastwood G, Royle SG. Comparison of pain perceived when using pneumatic or silicone ring tourniquets for local anaesthetic procedures in the upper limb. J Hand Surg Eur Vol 2012; 37:842-7. [PMID: 22719004 DOI: 10.1177/1753193412449116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to evaluate the level of pain felt when silicone ring and pneumatic tourniquets were applied to the upper arm and to determine which was more suitable for use in local anaesthetic procedures. Pain was measured using a visual analogue score pain scale on application and at 1, 5, and 10 minutes in 30 volunteers. Volunteers experienced significantly more pain on application and at 1 and 5 minutes with the silicone ring tourniquet. This difference in pain was most marked on application. Two volunteers could not tolerate application of the silicone ring tourniquet. We conclude that the silicone ring tourniquet would not be suitable for local anaesthetic procedures in the upper limb due to the severe pain experienced on application, which may reduce the patients' confidence and adversely affect their experience of the procedure. The pneumatic tourniquet is more suitable for local procedures.
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Affiliation(s)
- O J Smith
- Trauma and Orthopaedics Unit, Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, UK.
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A sterile elastic exsanguination tourniquet is effective in preventing blood loss during hemodialysis access surgery. J Vasc Access 2012; 14:116-9. [PMID: 23080335 PMCID: PMC6159822 DOI: 10.5301/jva.5000107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2012] [Indexed: 12/03/2022] Open
Abstract
Purpose We report the first use of a sterile elastic exsanguination tourniquet (SET) in performing hemodialysis vascular access procedures in 27 patients. The main advantages of this tourniquet are the reduction of blood loss and need for possible transfusions. Additional benefits are the near-perfect exsanguination and excellent exposure of the operative field. Methods This SET is a sterile elastic stockinet device that rolls up the arm starting from the hand by pulling on two handles. The elastic silicone ring provides sufficient pressure (220 ± 30 mmHg) to block arterial flow into the limb. The stockinet can be cut to provide access to the incision area while providing an additional sterile cover over the rest of the limb. Results No transfusions were required in any patients. Minor adverse effects occurred in four patients, including a twisted vessel, a bleeding vascular branch, a tear in atrophic arm skin, and pain, all of which had resolved on subsequent follow-up. Operational recommendations to avoid these adverse effects are outlined. Conclusions We conclude that this sterile elastic exsanguination tourniquet is effective and safe in preventing bleeding during upper extremity hemodialysis vascular access procedures.
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