Effects of Digital Tourniquet Ischemia: A Single Center Study
Fisioterapia y Podología, Facultad de Medicina, Escuela Universitaria de Enfermería, Universidad Complutense de Madrid, Madrid, Spain.Dermatologic Surgery (Impact Factor: 2.11). 01/2013; 39(4). DOI: 10.1111/dsu.12115
BACKGROUND: There is little information regarding the detrimental effects of tourniquet ischemia, although it is a widely used technique in extremity surgery. We endeavored to study some of the physiologic changes involved in the finger during the ischemic phase and throughout the recovery phase after tourniquet release. MATERIALS AND METHODS: This was a single-center, prospective observational study involving healthy adults designed to assess the appropriate application time of a digital T-ring tourniquet without a pH or acidosis <7.0 to avoid any potential risk to local tissues. RESULTS: There was no pH difference before tourniquet application between men and women, but after tourniquet application, the women's fingers became more acidotic at 10 and 20 minutes than the mens', but after 30 minutes the acidosis of the two groups was similar. Participants who weighed less had a more acidotic pH level than heavier participants. LIMITATIONS: This study was performed in a laboratory setting on healthy people rather than on those with existing medical conditions, so clinical recommendations cannot be explicitly made. CONCLUSION: Tourniquet application time is precious. While operating under tourniquet control, the extremity becomes increasingly acidotic. Tourniquet ischemia longer than 20 minutes causes local acidosis and muscle fatigue. Women and persons who weighed less could reach acidotic pH values faster than men or heavier patients. If applications longer than 20 minute are expected, the tourniquet should be released at 20 minutes, allowing the finger to reperfuse for 3-5 minutes to clear the acidosis before reapplication of tourniquet.
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ABSTRACT: Comment on: Effects of digital tourniquet ischemia: a single center study. [Dermatol Surg. 2013]
Article: Undermining and Hemostasis[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND Undermining and hemostasis are basic surgical techniques that can have a significant impact on surgical outcomes. OBJECTIVE To review the mechanisms and techniques of undermining and hemostasis, with an emphasis on the advantages and limitations of each modality. MATERIALS AND METHODS The PubMed database was searched for articles with the keywords "undermining," "hemostasis," and "electrosurgery." RESULTS Whether performing blunt, sharp, or electrosurgical techniques, undermining at the appropriate depth and width is necessary for tissue movement during closures. Both excessive and inadequate undermining can compromise surgical healing. Surgical hemostasis techniques include pressure, suture ligation, topical hemostatic agents, and electrosurgery. Dermatologic surgeons should select the appropriate amount and type of hemostasis for each procedure. Particular care should be taken in performing electrosurgery, given the potential for complications. CONCLUSION Understanding and optimizing hemostasis and undermining will allow dermatologic surgeons to execute complex closures with minimal complications. © 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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