title: Use of a pneumatic tourniquet improves outcome following trans-tibial amputation.
abstract: BACKGROUND
  It is traditionally taught that a pneumatic tourniquet is contraindicated for trans-tibial amputations in patients with peripheral arterial disease. However, tourniquets are used successfully during total knee arthroplasty in elderly patients. Vascular patients undergoing a trans-tibial amputation have a high perioperative mortality and morbidity-notably the need for wound revision or a higher amputation level. We hypothesised that a tourniquet, used during amputation, would reduce blood loss and subsequent complications without compromising healing.
  
  
  METHODS
  This was a prospective non-randomized study of 89 adult patients who underwent a trans-tibial amputation between January 2001 and December 2003. The endpoints were: haemoglobin levels, the need for blood transfusion, perioperative morbidity, revision rate and mortality. Patients were divided into two groups: a group with a pneumatic tourniquet (n=42) and a group without (n=47).
  
  
  RESULTS
  The haemoglobin fall was 14.8% in the non-tourniquet group and 5.6% in the tourniquet group, with a higher need for transfusion in the non-tourniquet group. The revision rate was 14.3% in the tourniquet group and significantly higher in the non-tourniquet group (38.3%). Mortality was similar in both groups: 7.1% for the tourniquet and 6.4% for the non-tourniquet group.
  
  
  CONCLUSIONS
  The use of a pneumatic tourniquet is safe and significantly reduces both blood loss and transfusion requirements during trans-tibial amputation. A pneumatic tourniquet reduces revision rates by over 50%, with subsequent cost savings.
authors.affiliation: Exeter Vascular Service, Royal Devon and Exeter NHS Foundation Trust and Peninsula Medical School, Exeter EX2 5DW, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Wolthuis
authors.forename: E
authors.initials: E
authors.lastname: Whitehead
authors.forename: B M F
authors.initials: BM
authors.lastname: Ridler
authors.forename: A R
authors.initials: AR
authors.lastname: Cowan
authors.forename: W B
authors.initials: WB
authors.lastname: Campbell
authors.forename: J F
authors.initials: JF
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D050197:Atherosclerosis / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D013977:Tibia / Q000098:blood supply / Q000601:surgery*; D014111:Tourniquets; D016896:Treatment Outcome