Tourniquet Paralysis Syndrome

The Crepe Bandage as an Alternative to the Esmarch Bandage for Upper Limb Exsanguination: A Volumetric Comparison Study

“…The high torque and shear forces generated mainly at the edge of the bandage are held responsible for such damage (Rhys-Davies and Stotter, 1985). Nerve damage is also thought to occur occasionally as a result of localized soft tissue distortion and nerve ischaemia (Moldaver, 1954). It has been the preference of the senior author to use the crepe bandage in hand surgery for some years and, in his experience, it provides excellent exsanguination.…”

“…Its elastic properties result in very high pressures being applied to the limb, which lead to better exsanguination than other methods such as the Rhys-Davies exsanguinator and simple elevation. The Esmarch bandage, however, has been associated with potential hazards and sterilization difficulties (Asirvatham et al, 1990;Darmanis et al, 2002;Marshall et al, 1994;Moldaver, 1954;Rhys-Davies and Stotter, 1985). The excessive shear forces applied to the skin produce pain and limit its use in the conscious patient.…”

Early Biochemical and Hemodynamic Changes after Operation in a Bloodless Field

“…It is commonly accepted that tourniquet application to a leg should not exceed 2 h. Irreversible tourniquet paralysis has been described [15], but the etiology is not clear. Degenerative muscular and liistochemical changes even after 30 min ischemia have been described in rats [4].…”

“…Tourniquet paralysis is a serious complication of ischemia although relatively infrequent [15]. The acute interruption of blood flow causes metabolic disorders which could be of importance in the pathogenesis of tourniquet injuries.…”

Tourniquet-induced neuromuscular injury

“…Nerve injury tends to be greater beneath the tourniquet than distal to it, due to the combined effects of ischemia and direct mechanical deformation (Denny-Brown and Brenner 1944, Moldaver 1954, Lundborg 1970, Fowler et al 1972, Ochoa et al 1972, Rudge 1974, Bolton and McFarlane 1978, Rorabeck 1980, Rorabeck and Kennedy 1980, Yates et al 1981, Nitz 1982. Relatively little information is available regarding critical pressure and time limits for muscle injury induced by pneumatic tourniquet compression (Patterson and Klenerman 1979, Patterson et al 1981, Gersoff et al 1989.…”