Effects of Digital Tourniquet Ischemia: A Single Center Study

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BACKGROUNDThere is little information regarding the detrimental effects of tourniquet ischemia, although it is a widely used technique in extremity surgery. We endeavored to study some of the physiologic changes involved in the finger during the ischemic phase and throughout the recovery phase after tourniquet release.MATERIALS AND METHODSThis was a single-center, prospective observational study involving healthy adults designed to assess the appropriate application time of a digital T-ring tourniquet without a pH or acidosis <7.0 to avoid any potential risk to local tissues.RESULTSThere was no pH difference before tourniquet application between men and women, but after tourniquet application, the women's fingers became more acidotic at 10 and 20 minutes than the mens', but after 30 minutes the acidosis of the two groups was similar. Participants who weighed less had a more acidotic pH level than heavier participants.LIMITATIONSThis study was performed in a laboratory setting on healthy people rather than on those with existing medical conditions, so clinical recommendations cannot be explicitly made.CONCLUSIONTourniquet application time is precious. While operating under tourniquet control, the extremity becomes increasingly acidotic. Tourniquet ischemia longer than 20 minutes causes local acidosis and muscle fatigue. Women and persons who weighed less could reach acidotic pH values faster than men or heavier patients. If applications longer than 20 minute are expected, the tourniquet should be released at 20 minutes, allowing the finger to reperfuse for 3–5 minutes to clear the acidosis before reapplication of tourniquet.

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