Tourniquet Injuries In Hand Surgery: Prevention And Management In University of Calabar Teaching Hospital

Ozinko M.O., Otei O.O., Ekpo R.G., Isiewele E.

Background: Tourniquet is commonly used in hand surgery to provide bloodless field that will facilitate dissection although fraught with complications. Aims: This study is aimed at identifying complications associated with the use of tourniquet in our practice as well as their prevention and management. Materials and Methods: Our cohort included 152 patients who underwent one of the most common procedures in the unit for hand trauma or infection, tumours including ganglion, syndactyly, trigger finger and camptodactyly with an average follow up period of 8 months. Exclusion criteria included incomplete notes, no documented post operative follow- up, pre-existing soft tissue damage or neurological lesion affecting the limb concerned. 25 patients were excluded because of incomplete or missing notes, 4 no follow-up records and 2 pre-existing nerve or soft tissue injury in the affected hand. Medical notes relating to the cohort were documented, the type of procedures, tourniquet time, adequacy of the bloodless field using the quantity of the estimated blood loss and any intra-operative or post-operative complications were also ascertained.Results: 121 patients fulfilled the inclusion criteria and were reviewed for the purpose of the study with male to female ratio of 1:1.6, average age of 45years ranging from 8 months to 72 years. A total of 5 post operative complications were identified: 2 nerve injuries, (neuropraxia which resolved within 6months and post operative tourniquet pain in 3 patients). The use of tourniquet was discontinued in 3 patients due to venous tourniquet effect with inadequate bloodless field. The duration of tourniquet varies between 30 minutes and 108 minutes with an average interval of 86 per 10minutes. Conclusion: The use of tourniquet is often followed with complications for which the pathophysiology, their preventive measures and management should be known by limb surgeons if they should arise.