Clinical Consequences of Different Exsanguination Methods in Hand Surgery. A Double-blind Randomised Study

Abstract

A randomised trial was performed in 100 patients in order to evaluate the effectiveness of three commonly used methods of exsanguination (simple elevation, squeeze method and Esmarch bandage) in a clinical setting. The quality and quantity of the exsanguination was evaluated every 5 min by the surgeon and the amount of oozing was observed. Although there was no significant difference between squeezing the arm and Esmarch bandaging, both resulted in significantly better exsanguination than simple elevation. In 22 out of the 100 patients, a small amount of ooze was observed. The oozing was observed significantly more frequently in the patients exsanguinated by simple elevation.

Tourniquet Usage in Upper Extremity Surgery

“…Blønd et al 15 performed a randomized, blinded trial to further evaluate the optimal method. With the surgeon absent, patients were randomized and underwent exsanguination via elevation for 5 seconds, the squeeze method, or Esmarch bandage.…”

Tourniquet in Surgery of the Limbs: A Review of History, Types and Complications

“…One study concluded that the time of up righting doesn't differ in 5, 15, 30, 45 seconds, and 1-4 minutes ( 29 ). The methods of limb blood draining have been compared to each other as well with the Esmarch method and blood sucking equal for surgeon convenience in practice and were better than just up righting alone ( 30 ). Lower pressure is needed with wider tourniquet cuffs ( 31 ).…”

The deleterious effects of exsanguination with a tight bandage on tourniquet tolerance in the upper arm

“…Surgeons generally prefer bandaging rather than limb elevation because it is thought to be less time consuming and more effective in creating a bloodless field (Blond and Madsen, 2002;Rorabeck, 1980). Blond et al (2008) found that exsanguination by limb elevation caused significantly more oozing intra-operatively compared with the squeeze method and Esmarch bandage. However, tightly squeezing the limb with an elastic bandage is traumatic.…”