The Impact of Tourniquet Release Time on Wound Healing in Patients Undergoing Tibia Fracture Plating Surgery

Abstract

Background: The use of tourniquet is very common in orthopedic surgeries. By obstructing blood flow in the limb, tourniquet may result in muscle ischemia and skin flap hypoxia. This study aimed at determining and comparing the effects of tourniquet release time on wound healing in patients undergoing tibia fracture plating surgery. Methods: This study was a randomized clinical trial, wherein 40 patients with acute extra-articular tibia fractures were randomly assigned to 2 groups of A (releasing the tourniquet after fracture fixation and before wound closure) and B (releasing the tourniquet after wound closure and application of compression dressing). Duration of surgery in each group was recorded and independent t test was utilized to compare the 2 groups. The wound healing rate was investigated in the patients 24 hours and 14 days after surgery using the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale. In this tool, 0 represents "lack of the variable" and 3 indicates "maximum variable score". The scores in this scale range from 0 to 15. The Mann-Whitney test was used in order to compare the wound healing rates between the 2 groups. Results: There was no significant difference between the 2 groups concerning the average duration of surgery. Wound redness, edema, ecchymosis, discharge, approximation, and the general condition of wound healing showed no significant difference in the 2 groups 24 hours after surgery, while there was a significant difference 14 days after surgery with the aforementioned parameters being greater in group B than group A. Conclusions:The results showed that releasing the tourniquet before wound closure in group A led to improved wound healing. Wounds need oxygen for restoration and prevention from infections. As the use of tourniquet occludes blood flow to the limb for a while, it can result in increased wound hypoxia after surgery and delayed healing process; hence, less tourniquet time is more desirable for oxygenation of tissues and wound dryness.

The Effect of Foot Reflexology Applied Before Coronary Angiography and Percutaneous Transluminal Coronary Angioplasty on Anxiety, Stress, and Cortisol Levels of Individuals

“…Patients in the reflexology group received reflexology therapy on their feet bilaterally with the appropriate angle and intensity for a total of 30 minutes before CAG and PTCA. Reflexology was first applied to the left foot and then to the right one 15,18,23 . After relaxation techniques, reflexology was applied to the feet of the patients with appropriate angle and intensity by focusing on the points related to the solar plexus, brain, paranasal cavity, pituitary gland, neck, lung/chest and heart, diaphragm, solar plexus, adrenals, cervical spine, lumbar vertebrae, sacrum, and solar plexus that were thought to affect anxiety and stress responses 14,15,18,19,23,24 .…”

“…Reflexology was first applied to the left foot and then to the right one 15,18,23 . After relaxation techniques, reflexology was applied to the feet of the patients with appropriate angle and intensity by focusing on the points related to the solar plexus, brain, paranasal cavity, pituitary gland, neck, lung/chest and heart, diaphragm, solar plexus, adrenals, cervical spine, lumbar vertebrae, sacrum, and solar plexus that were thought to affect anxiety and stress responses 14,15,18,19,23,24 . After the completion of the reflexology procedure, general leg-foot patting was performed to relieve the patients 15,23 .…”

“…The form was developed in light of the relevant literature to collect data about age, gender, educational levels, and marital status 10,15,17,18,24 …”

“…In the study by Molavi Vardanjani et al, 15 the anxiety level of the patients who would have CAG procedure was found to be significantly lower in the group that was applied a general foot massage and foot reflexology for 30 minutes than the group that had only massage. In another study, 20 minutes of foot reflexology application before CAG was found to be effective in reducing anxiety 18 . In a study by Choi and Lee, reflexology was found to reduce cortisol levels in postpartum women 19 .…”

“…There are several studies in the literature examining the effects of pre-CAG reflexology application on anxiety 7,10,15,18,21,22 . However, there was no study investigating the effect of foot reflexology on stress and cortisol levels in patients undergoing CAG and PTCA for the first time.…”