Survey of tourniquet use in orthopaedic foot and ankle surgery.
BACKGROUND
Tourniquet technique varies among foot and ankle surgeons, and to establish a standard practice guideline the current standard of care should be examined.


METHODS
One hundred and forty responses were received after 253 surveys were mailed to American Orthopaedic Foot and Ankle Society (AOFAS) members, concerning type of tourniquets, location, and pressures used.


RESULTS
Cuff pressures most commonly used were 301 to 350 mmHg for thigh cuffs (49% of thigh cuff users) and 201 to 250 mmHG for calf and ankle cuffs (52% of calf cuff users, 66% of ankle cuff users). A substantial number of foot and ankle surgeons who use calf and ankle cuffs frequently use pressures above 250 mmHg (41% of calf cuff users, 19% of ankle cuff users). Only 9% use limb occlusion pressure when determining cuff pressure.


CONCLUSIONS
Based on the existing evidence-based literature these pressures may be higher than necessary for many patients, and increased adoption of optimal pressure setting techniques as reported in the literature may help reduce tourniquet pressures used and risk of tourniquet injury. Respondents reported experiencing or hearing reports of breakthrough bleeding, nerve injury, and skin injuries under the cuff.
Younger
Alastair S E
AS
1160 Burrard St. Suite 401, Vancouver, BC Canada V6Z 2A5. asyounger@shaw.ca
Kalla
Timothy P
TP
McEwen
James A
JA
Inkpen
Kevin
K
D000842:Ankle / Q000601:surgery*; D003625:Data Collection; D019317:Evidence-Based Medicine; D005528:Foot / Q000601:surgery*; D006801:Humans; D007866:Leg; D009864:Ontario; D009985:Orthopedics; D059348:Peripheral Nerve Injuries; D011312:Pressure; D012307:Risk Factors; D014111:Tourniquets / Q000009:adverse effects / Q000706:statistics & numerical data*; D014481:United States