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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE
A Journal on Physiopathology and Surgery of the Foot
Indexed/Abstracted in: EMBASE, Scopus
Chirurgia Del Piede 2004 June;28(2):71-8
Hemostatic tourniquet management in orthopedic surgery of the lower extremity
Napoli V., Napoli E., Tempia A.
The use of the hemostatic tourniquet in the orthopedic surgery of the lower extremity is now a consolidated, advantageous practice in so far as it enables the anatomic structures to be more easily identified and minimises the risk of accidental surgical lesions to vessels and nerves. It is, however, accompanied by mechanical, hemodynamic and biochemical variations that must be known and managed if they are to be prevented from leading to at times severe locoregional and systemic complications. Safety of tourniquet use is therefore bound up with rigorous respect for a number of unavoidable rules: ‹ complete, preliminary evacuation of blood from the extremity by centripetal force; ‹ preferential positioning on the upper third of the thigh; ‹ use of pressure that is no greater than once, one and a half times systemic pressure, on average 250-300 mmHg; ‹ maximum duration of the period of ischaemia no longer than 120 minutes; ‹ use of a second period of ischaemia only for serious and not otherwise controllable haemorrhagic complications.