scholarly journals Tourniquet in Plastic Surgery

2016 ◽  
Vol 2 (1) ◽  
pp. 9-19
Author(s):  
Abhishek Vijayakumar ◽  
Keyword(s):  
Reperfusion Injury ◽  
Plastic Surgery ◽  
Operative Time ◽  
Systemic Effect ◽  
Vascular Lesions ◽  
Occlusion Pressure ◽  
Tourniquet Time ◽  
Bloodless Field ◽  
Limb Occlusion Pressure ◽  
Easy Operation

Tourniquet is invaluable instrument to plastic, hand and orthopedic surgeon. It helps create a bloodless field for easy operation and reduces operative time. The advantages of tourniquet is no without its share of complication including nerve and skin injuries and devastating vascular lesions leading to amputation or death. A thorough understanding of the local and systemic effect of tourniquet is essential to minimize the complication. Various physical and pharmacological modifications reduce the reperfusion injury and also help increase tourniquet time. This review discusses the principle, physiology and complications of tourniquet. Keywords: Tourniquet, Limb occlusion pressure, Reperfusion injury, Nerve palsies, Limb protector sleeves.

scholarly journals Lower tourniquet cuff pressure reduces postoperative thigh pain in obese patients undergoing total knee arthroplasty

2019 ◽  
Vol 5 (3) ◽  
pp. 368
Author(s):  
Wenxian Png ◽  
Wuchean Lee ◽  
Mann Hong Tan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Cuff Pressure ◽  
Thigh Pain ◽  
Obese Patients ◽  
Occlusion Pressure ◽  
Bloodless Field ◽  
Total Knee ◽  
Limb Occlusion Pressure

<p class="abstract"><strong>Background:</strong> The use of high tourniquet pressures in obese patients undergoing total knee arthroplasty increases the risk of postoperative thromboembolic events and skin complications. Measurement of limb occlusion pressure (LOP) before surgery may lead to the use of lower tourniquet cuff pressure during surgery and thereby reduce the risk of postoperative pain and complications.</p><p class="abstract"><strong>Methods:</strong> Eighty-six obese patients scheduled for total knee arthroplasty were randomized to a control group (n=43) with tourniquet pressures at 300 mmHg or the LOP group (n=43) where a recommended tourniquet pressure was determined based on the patient’s limb occlusion pressure. The primary outcome measure was postoperative thigh pain; the secondary outcome measures were the quality of bloodless field, postoperative drop in haemoglobin, postoperative complications and Oxford knee scores.<strong></strong></p><p class="abstract"><strong>Results:</strong> The tourniquet cuff pressure was significantly lower in the LOP group than in the control group (p&lt;0.001). Patients in the LOP group showed significantly lower postoperative thigh pain scores till postoperative day 3. Our study did not show any difference in intraoperative quality of bloodless field (p&lt;0.103), postoperative complications and Oxford knee scores (p&lt;0.775) at six months after surgery.</p><p><strong>Conclusions:</strong> Our results show that the use of limb occlusion pressure method results in decreased postoperative thigh pain without reducing the quality of the bloodless field. We believe that this method in tourniquet application is safe and beneficial for the subset of obese patients undergoing total knee arthroplasty. </p>

Disparities between Operative Time and Relative Value Units for Plastic Surgery Procedures

2021 ◽  
Vol 148 (3) ◽  
pp. 638-644
Author(s):  
Jared A. Blau ◽  
Caitlin E. Marks ◽  
Brett T. Phillips ◽  
Scott T. Hollenbeck
Keyword(s):  
Plastic Surgery ◽  
Operative Time ◽  
Relative Value

scholarly journals Slight femoral under-correction versus neutral alignment in total knee arthroplasty with preoperative varus knees: a comparative study

Arthroplasty ◽  
2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Kai Lei ◽  
Li-Ming Liu ◽  
Peng-Fei Yang ◽  
Ran Xiong ◽  
De-Jie Fu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Clinical Results ◽  
Patient Reported Outcome Measures ◽  
Tourniquet Time ◽  
Patient Reported ◽  
Total Knee ◽  
Neutral Alignment

Abstract Background This study aimed to compare the short-term clinical results of slight femoral under-correction with neutral alignment in patients with preoperative varus knees who underwent total knee arthroplasty. Methods The medical records and imaging data were retrospectively collected from patients who had undergone total knee arthroplasty in our hospital from January 2016 to June 2019. All patients had varus knees preoperatively. Upon 1:1 propensity score matching, 256 patients (256 knees) were chosen and divided into a neutral alignment group (n=128) and an under-correction group (n=128). The patients in the neutral group were treated with the neutral alignment. In the under-correction group, the femoral mechanical axis had a 2° under-correction. The operative time, tourniquet time and the length of hospital stay in the two groups were recorded. The postoperative hip-knee-ankle angle, frontal femoral component angle and frontal tibial component angle were measured. Patient-reported outcome measures were also compared. Results The operative time, tourniquet time and the length of hospital stay in the under-correction group were significantly shorter than the neutral alignment group (P<0.05). At the 2-year follow-up, the under-correction group had a larger varus alignment (P<0.05) and a larger frontal femoral component angle (P<0.05), and the frontal tibial component angles of the two groups were comparable. Compared with the neutral alignment group, the slight femoral under-correction group had significantly better patient-reported outcome measures scores (P<0.05). Conclusion For varus knees treated with total knee arthroplasty, alignment with a slight femoral under-correction has advantages over the neutral alignment in terms of the shorter operative time and better short-term clinical results. Level of evidence III

Retroperitoneal laparoscopic surgery in managing the urinary anormalies in children at Viet Duc Hospital

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Việt Hoa Nguyễn
Keyword(s):  
Laparoscopic Surgery ◽  
Retrospective Study ◽  
Plastic Surgery ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Multicystic Dysplastic Kidney ◽  
Gender Ratio ◽  
Laparoscopic Pyeloplasty ◽  
Ureteral Duplication ◽  
Dysplastic Kidney

Tóm tắt Đặt vấn đề: Đánh giá kết quả phẫu thuật nội soi sau phúc mạc điều trị bệnh lý thận, tiết niệu ở trẻ em Phương pháp nghiên cứu: Nghiên cứu hồi cứu người bệnh phẫu thuật nội soi sau phúc mạc điều trị bệnh lý thận, tiết niệu trong thời gian từ 1/1/2014 - 31/12/2017. Kết quả: Phẫu thuật nội soi sau phúc mạc cho 110 người bệnh trong đó hẹp khúc nối bể thận - niệu quản là 49 người bệnh (44,54%), thận niệu quản đôi 23 người bệnh (20,91%), thận đa nang 21 người bệnh (19,1%), thận teo mất chức năng 17 người bệnh (15,43%). Tuổi phẫu thuật trung bình là 4,5 ± 3,72 tuổi (từ 1 tuổi- 15 tuổi), tỉ lệ nam/ nữ = 3,3/1. Phẫu thuật nội soi cắt thận cho 52 người bệnh (47,27%), nội soi tạo hình cho 11 người bệnh (10%), nội soi hỗ trợ tạo hình cho 47 người bệnh (42,73%). Thời gian phẫu thuật trung bình 100 ± 20 phút. Thời gian nằm viện sau mổ trung bình là 3 ± 2,3 ngày. Không có biến chứng nặng. Kết quả theo dõi sau mổ 3- 36 tháng cho kết quả tốt 88%, trung bình 10%, xấu 2% Kết luận: Nội soi sau phúc mạc điều trị các bệnh lý thận, tiết niệu ở trẻ em là một phương pháp phẫu thuật an toàn, không có biến chứng, thẩm mỹ và cho kết quả tốt. Abstract Introduction: To evaluate the retroperitoneal laparoscopic surgery in children having the urinary anomalies Material and Methods: Retrospective study for children suffering from urinary anomalies underwent retroperitoneal laparoscopic surgery. Results: 110 children were operated by retroperitoneal laparoscopic approach included: 49 patients (44.54%) with ureter pelvic junction obstruction, 23 patients (20.91%) with ureteral duplication, 21 patients (19.1%) with multicystic dysplastic kidney, 17 patients (15.45%) with atrophy kidney. Mean age was 4.5± 3.72 years old (from 1 year to 15 years old); Gender ratio: male/female = 3.3/1. Laparoscopic nephrectomy for 52 cases (47.27%), 58 cases including 11 cases (10%) retroperitoneal laparoscopic pyeloplasty and 47 cases (42.27%) with assisted laparoscopic plastic surgery. Mean operative time was 100 ± 20 minutes, mean hospitalization length stay was 3 ± 2.3 days. No major complications occurred. Followed from 3 to 36 month are favorable with good outcome in 88%, average in 10%, poor in 2%. Conclusion: Retroperitoneal laparoscopic surgery is safe and feasible procedure in children with urinary anomalies. Keyword: Laparoscopic surgery; Retroperitoneal laparoscopic surgery; Urinary anomalies in children.

Survey of Tourniquet Use in Orthopaedic Foot and Ankle Surgery

2005 ◽  
Vol 26 (3) ◽  
pp. 208-217 ◽  
Author(s):  
Alastair S.E. Younger ◽  
Timothy P. Kalla ◽  
James A. McEwen ◽  
Kevin Inkpen
Keyword(s):  
Cuff Pressure ◽  
Standard Of Care ◽  
Foot And Ankle ◽  
Occlusion Pressure ◽  
Current Standard ◽  
Breakthrough Bleeding ◽  
Pressure Setting ◽  
Ankle Surgery ◽  
American Orthopaedic ◽  
Limb Occlusion Pressure

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. Conclusion: 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.

scholarly journals Efficiency and Blood Loss of Various Spacer and Intramedullary Dowel Constructs in Two-Stage Treatment of Total Knee Arthroplasty

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Hanna House, BS ◽  
Mary Ziemba-Davis, BA ◽  
Michael Meneghini, MD
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Operating Time ◽  
Treatment Protocol ◽  
Two Stage ◽  
Tourniquet Time ◽  
Infected Total Knee Arthroplasty ◽  
Total Knee

Background and Hypothesis: Treatment for infected total knee arthroplasty (TKA) employs antibiotic-eluding articulating or static spacers, with or without intramedullary (IM) dowels between implant resection and reimplantation. While it is unknown which spacer type is more efficient intra-operatively, IM dowels require additional time for fabrication. Surgical efficiency is critical to minimizing anesthesia time and blood loss, especially in complex surgeries with compromised hosts. We quantified operative time and postoperative intra-articular blood loss based on spacer type and the use of IM dowels. Project Methods: 103 consecutive infected TKAs treated from 2010-2019 were retrospectively reviewed. Outcome variables included operative time and intraarticular drain rate. Covariates included sex; age, BMI; ASA-PS classification; surgeon; McPherson infection classification; tourniquet time; tranexamic acid (TXA) use; intrathecal anesthesia, length of stay, and blood transfusion. Multivariate analyses were used. Results: The sample was 52% female with average age of 66±9 years and average BMI of 36±9 kg/m2. Articulating spacers without dowels (ASwoD), articulating spacers with dowels (ASwD), and static spacers with dowels were used in 57.3%, 21.4%, and 21.4% of knees, respectively. Longer mean operating time was observed when static spacers with dowels were used at resection (162 vs.130 ASwoD/140 ASwD minutes; p=0.001) and reimplantation (187 vs. 149 ASwoD/148 ASwD minutes; p=0.017). At reimplantation, drain rate was highest when articulating spacers with dowels were used (37 vs. 20/26 mL/hr), but not when TXA was used (p=0.002). Conclusion and Potential Impact: Articulating and static spacers provide equivalent infection eradication, and the necessity of IM dowels has not been thoroughly studied. In light of this equivalency, it is important to understand other costs associated with spacer types and IM dowels. Our observations that spacer/dowel constructs affect time under anesthesia and blood loss may contribute to the efficiency and safety of the two-stage treatment protocol.

scholarly journals MEASURING LIMB OCCLUSION PRESSURE USING DIFFERENT VASCULAR DOPPLERS

2020 ◽  
Vol 52 (7S) ◽  
pp. 889-889
Author(s):  
Kiara B. Barrett ◽  
Logan B. Page ◽  
Marcin K. Szczyglowski ◽  
Tyler D. Martin ◽  
J. Grant Mouser
Keyword(s):  
Occlusion Pressure ◽  
Limb Occlusion Pressure

scholarly journals Investigation of clinically acceptable agreement between two methods of automatic measurement of limb occlusion pressure: a randomised trial

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Luke Hughes ◽  
James McEwen
Keyword(s):  
Standard Error ◽  
Cuff Pressure ◽  
Randomised Trial ◽  
Automatic Measurement ◽  
Lower Limbs ◽  
Occlusion Pressure ◽  
Pneumatic Tourniquet ◽  
Dual Purpose ◽  
Limb Occlusion Pressure ◽  
Acceptable Agreement

Abstract Background Development of automatic, pneumatic tourniquet technology and use of personalised tourniquet pressures has improved the safety and accuracy of surgical tourniquet systems. Personalisation of tourniquet pressure requires accurate measurement of limb occlusion pressure (LOP), which can be measured automatically through two different methods. The ‘embedded LOP’ method measures LOP using a dual-purpose tourniquet cuff acting as both patient sensor and pneumatic effector. The ‘distal LOP’ method measures LOP using a distal sensor applied to the patient’s finger or toe of the operating limb, using photoplethysmography to detect volumetric changes in peripheral blood circulation. The distal LOP method has been used clinically for many years; the embedded LOP method was developed recently with several advantages over the distal LOP method. While both methods have clinically acceptable accuracy in comparison to LOP measured using the manual Doppler ultrasound method, these two automatic methods have not been directly compared. The purpose of this study is to investigate if the embedded and distal methods of LOP measurement have clinically acceptable agreement. The differences in pairs of LOP measurement in the upper and lower limbs of 81 healthy individuals were compared using modified Bland and Altman analysis. In surgery, it is common for cuff pressure to deviate from the pressure setpoint due to limb manipulation. Surgical tourniquet systems utilise a ± 15 mmHg pressure alarm window, whereby if the cuff pressure deviates from the pressure setpoint by > 15 mmHg, an audiovisual alarm is triggered. Therefore, if the difference (bias) ± SE, 95% CI of the bias and SD of differences ± SE in LOP measurement between the embedded and distal methods were all within ±15 mmHg, this would demonstrate that the two methods have clinically acceptable agreement. Results LOP measurement using the embedded LOP method was − 0.81 ± 0.75 mmHg (bias ± standard error) lower than the distal LOP method. The 95% confidence interval of the bias was − 2.29 to 0.66 mmHg. The standard deviation of the differences ± standard error was 10.35 ± 0.49 mmHg. These results show that the embedded and distal methods of LOP measurement demonstrate clinically acceptable agreement. Conclusions The findings of this study demonstrate clinically acceptable agreement between the embedded and distal methods of LOP measurement. The findings support the use of the embedded LOP method of automatic LOP measurement using dual-purpose tourniquet cuffs to enable accurate, effective and simple prescription of personalised tourniquet cuff pressures in a clinical setting.

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