Subcutaneous thigh fat necrosis as a result of tourniquet control during total knee arthroplasty

Department of Orthopaedic Surgery, Norfolk & Norwich University Hospital, Norwich, UK.
Annals of The Royal College of Surgeons of England (Impact Factor: 1.27). 10/2005; 87(5):W11-3. DOI: 10.1308/147870805X60761
Source: PubMed

ABSTRACT The use of a pneumatic tourniquet in total knee arthroplasty has been linked to complications caused by local tissue hypoxia. Fat necrosis is a rare condition that presents as an ill-defined subcutaneous lesion. The clinical features resemble that of a lipoma but histological appearance is characteristic. Ultrasound imaging is helpful in establishing the diagnosis both by sonographic appearance as well as in directing a biopsy if necessary. We present a case of encapsulated fat necrosis caused by the use of a pneumatic tourniquet during total knee arthroplasty.

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    • "Other tourniquet-related complications have been reported in the literature and include nerve palsy [10], vascular injuries [15], rhabdomyolysis [24], and subcutaneous thigh fat necrosis [32]. The application of a tourniquet also tethers the quadriceps mechanism and thus alters the intraoperative patellofemoral tracking [11, 14, 19]. "
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    ABSTRACT: The use of an intraoperative tourniquet for total knee arthroplasty (TKA) is a common practice. However, the effectiveness and safety are still questionable. A systematic review was conducted to examine that whether using a tourniquet in TKA was effective without increasing the risk of complications. A comprehensive literature search was done in PubMed Medicine, Embase, and other internet database. The review work and the following meta-analysis were processed to evaluate the role of tourniquet in TKA. Eight randomized controlled trials and three high-quality prospective studies involving 634 knees and comparing TKA with and without the use of a tourniquet were included in this analysis. The results demonstrated that using a tourniquet could decrease the measured blood loss but could not decrease the calculated blood loss, which indicated actual blood loss. Patients managed with a tourniquet might have higher risks of thromboembolic complications. Using the tourniquet with late release after wound closure could shorten the operation time; whereas early release did not show this benefit. The current evidence suggested that using tourniquet in TKA may save time but may not reduce the blood loss. Due to the higher risks of thromboembolic complications, we should use a tourniquet in TKA with caution.
    Knee Surgery Sports Traumatology Arthroscopy 12/2010; 19(7):1121-30. DOI:10.1007/s00167-010-1342-7 · 3.05 Impact Factor
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    ABSTRACT: A total of 15 coppersmiths who do the job as a traditional profession in Kahramanmaras Province were retrospectively analyzed for revealing a possible relationship of lipoma formation and chronic compression, as the work characteristic related to mechanical pressure to the right thoracal and shoulder region. The workers were examined and their historical data were noted. Chronic compression sites in the patients were also evaluated by magnetic resonance imaging and ultrasonography. The ages were between 30 and 52 years. Body mass index ranged from 18.6 to 38.8. Five were operated for visible lipomatous masses at their injured sites. All of the specimens were reported as containing mature adipocytes. An increased subcutaneous fat thickness at the injured sides of the patients was seen when compared with the uninjured contralateral sides using ultrasonography. At the magnetic resonance images, no capsule intensity was observed in the lipomatose masses. Subcutaneous fat of injured right mammarial regions was thicker than the other contralateral sides in all of the cases. The most prominent lipomas were seen in obese workers, and strong evidence for chronic trauma and lipoma formation as an occupational disease was obtained from the study.
    Annals of Plastic Surgery 10/2006; 57(3):275-8. DOI:10.1097/ · 1.49 Impact Factor
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    ABSTRACT: The subvastus surgical approach to total knee arthroplasty preserves the insertion of the vastus medialis tendon on the patella, thereby resulting in superior functional outcomes in the short term. This surgical approach was adapted to perform a consecutive series of primary uncemented total knees, without a thigh tourniquet, using a short-length incision. The outcomes are reported herein. One hundred fifteen primary total knees were performed using instrumentation optimized for minimally invasive surgery. Porous implants, including a monoblock trabecular metal tibial component, were implanted in each knee. Mean incision length was 4 in. Mean patient age was 67 years, and mean patient weight was 188 lb. No tourniquet was used in any knee, and a standard rehabilitation protocol was used with full weight-bearing after the operation. At a minimum follow-up of 12 months after surgery, 1 knee had undergone repeat surgery to revise a loose patella component. This complication was most likely related to an undisplaced patella fracture that occurred when the patient fell in the postoperative period. Another patient developed a deep venous thrombosis. No other complications occurred, and radiographs demonstrated satisfactory component positioning. Mean knee arc of motion at 4 weeks after surgery was 114 degrees, and most patients did not require formal physical therapy after a month after the operation. Because no muscle or tendon detachment is involved, the subvastus approach is ideally suited for minimally invasive surgery, especially if a thigh tourniquet is not used. The present series illustrates the safety, consistency, and reliability of this technique in a consecutive series of patients with knee arthritis. Faster patient recovery and greater patient satisfaction were achieved, without increased complications.
    Techniques in Knee Surgery 02/2007; 6(1):60-67. DOI:10.1097/btk.0b013e3180326f6e
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