ORIGINAL ARTICLES   

Chirurgia Del Piede 2000 March;24(1):17-28

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Metabolic effects of tourniquet ischemia in leg surgery

Napoli V., Pettiti G., Minicucci S., Gariboldi A., Pisani P. C.

The compression of a pneumatic tourniquet and induced ischemia allows the anatomic structures to be identified with extreme precision and facilitates foot surgery. The use of the tourniquet is burdened by the possible induction of compressive and ischemic damage unless preventive measures are taken. Compressive damage can be avoided by positioning the tourniquet at the bottom of the thigh where the abundant muscle tissue acts as a shock absorber, and by limiting insufflation pressure to 2-2.5 times systemic pressure. Both local ischemic damage, linked to the abnormal production and accumulation of acid metabolites during the anaerobic phase, and systemic damage linked to their release into the circulation after the tourniquet has been removed, can be avoided by limiting ischemia time. Our study of 100 non-selected patients undergoing elective foot surgery highlights the close correlation between the duration of ischemia, the production of acid metabolites and the maintenance of the acid-base balance. When ischemia is limited to less than 120 minutes, organic regulation mechanisms can buffer the metabolites produced, reinstating the acid-base balance without the need for external intervention and with no clinical signs of cell lesions.