title: In-vivo analysis of epicutaneous pressure distribution beneath a femoral tourniquet--an observational study.
abstract: BACKGROUND
  Compression of the tissue beneath tourniquets used in limb surgery is associated with varying degrees of soft tissue damage. The interaction between fluids and applied pressure seems to play an important role in the appearance of skin lesions. The extent of the transfer of force between the tourniquet and the skin, however, has yet to be studied. The aim of the present study was to quantify in-vivo the transfer of pressure between a tourniquet and the skin of the thigh.
  
  
  METHODS
  Pressure under the tourniquet was measured using sensors in 25 consecutive patients over the course of elective surgical procedures. Linear mixed modeling was used to assess the homogeneity of the distribution of pressure around the circumference of the limb, variation in pressure values over time, and the influence of limb circumference and the Body-Mass-Index (BMI) on pressure transfer.
  
  
  RESULTS
  Mean pressure on the skin was significantly lower than the inner pressure of the cuff (5.95%, 20.5 ± 9.36 mmHg, p < 0.01). There was a discrete, but significant (p < 0.001) increase in pressure within the first twenty minutes after inflation. Sensors located in the area of overlap of the cuff registered significantly higher pressure values (p < 0.01). BMI and leg circumference had no influence on the transfer of pressure to the surface of the skin (p = 0.88 and p = 0.51).
  
  
  CONCLUSIONS
  Pressure transfer around the circumference of the limb was distributed inhomogeneously. The measurement series revealed a global pressure drop compared to the initial pressure of the cuff. No relationship could be demonstrated between the pressure transferred to the skin and the BMI or limb circumference.
authors: Department of Orthopedics and Traumatology, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. eddi.roth@unimedizin-mainz.de.
authors: Klaus Edgar
authors: KE
authors: Roth
authors: Department of Orthopedics and Traumatology, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. Boris.Mandryka@bgu-murnau.de.
authors: Boris
authors: B
authors: Mandryka
authors: Department of Orthopedics and Traumatology, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. gerrit.s.maier@gmx.de.
authors: Gerrit Steffen
authors: GS
authors: Maier
authors: Department of Orthopedics and Traumatology, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. uwemaus@online.de.
authors: Uwe
authors: U
authors: Maus
authors: Institut für Medizinische Biometrie, Epidemiologie und Informatik, Unimedizin Mainz und RheinAhrCampus der Hochschule Koblenz, Mainz, Germany. berres@rheincampus.de.
authors: Manfred
authors: M
authors: Berres
authors: OrthoTrauma Evaluation Institute, Mainz, Germany. profrompe@web.de.
authors: Jan-Dirk
authors: JD
authors: Rompe
authors: Department of Orthopedics and Traumatology, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. bodem@uni-mainz.de.
authors: Friedrich
authors: F
authors: Bodem
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000209:etiology; D013848:Thigh / Q000033:anatomy & histology / Q000502:physiology*; D014111:Tourniquets / Q000009:adverse effects; D055815:Young Adult
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