SLR - February 2023 - Kelly Kugach, DPM
Title: Extended Tourniquet Times and the Impact on Wound Healing in Foot SurgeryReference: Robertson C, Wilson V, Meek RMD, Carter R. Extended Tourniquet Times and the Impact on Wound Healing in Foot Surgery. Clin Med Res. 2022 Aug 26:cmr.2022.1668. doi: 10.3121/cmr.2022.1668. Epub ahead of print. PMID: 36028284.
Level of Evidence: Level 3
Reviewed By: Kelly Kugach, DPM
Residency Program: Carilion Clinic, Roanoke, VA
Podiatric Relevance: Tourniquets are frequently used in foot and ankle surgery. This article aims to test the hypothesis that there is no significant difference in ankle surgery wound healing with thigh tourniquet times greater than or less than 120 minutes.
Methods: A retrospective comparative study was performed on 96 patients operated on by a single surgeon from September 2015 to February 2018 obtained through EMR. Inclusion Criteria: any patient receiving a STJ or Triple arthrodesis, revision procedures, or hindfoot arthroplasty. Exclusion Criteria: subsequent revisions during the above time period and any patients deemed significantly non-compliant postop. The thigh tourniquet was inflated to 300 mmHg on all patients. 55 patients had their tourniquet inflated >120 minutes, 41 patients with <120 minutes. The patients were evaluated for surgical wound healing, discharge date, and complication rate.
Results: No significant difference in wound healing time, discharge date, or complication rate were found between groups. Eleven patients were excluded for “operative failure”, including 6 in the <120 minute group and 5 in the >120 minute group for re-admission with either IV antibiotics, reoperation, and skin grafting.
Conclusions: This article concluded tourniquet times up to 3 hours with pressure up to 300 mmHg are not associated with differences in surgical wound healing. The data may be skewed though due to exclusion of patients that were re-admitted for operative failure. Given this, the data does not fully reflect all wound healing complications. The article also concludes no difference in infection rates, postoperative bleeding, DVT, or compartment syndrome. Of note, these results were not primarily focused on. The article also not address nerve related complications or postoperative pain. Overall, this article sheds light on the possibility of wound healing complications associated with tourniquet use.