Year 2024 / Volume 35 / Number 1

Original Papers

Use of Limb Occlusion Pressure as a method for calculation of intraoperative ankle tourniquet pressure in forefoot surgery: a prospective case series

Rev. Esp. Pod. 2024; 35(1): 4-10 / DOI: 10.20986/revesppod.2024.1676/2023

Javier Pascual Huerta, Leticia Palacio Fernández, Lucía Trincado Villa, Antonio González Fernández, Eduardo Mongil Escudero


ABSTRACT

Objetives: The use of tourniquets in foot surgery can produce complications. It was assessed que quality of surgical fi eld hemostasis and its complications with the use of an ankle tourniquet whose pressure was determined by using the Limb Occlusion Pressure (LOP) method.
Patients and methods: Patients surgically treated with an ankle tourniquet were included. Pressure of the tourniquet was calculated using LOP method with a cuff at the ankle until Doppler stethoscope sound was not detected. A security margin was added of 40, 60 or 80 mm Hg if LOP value was less than 130, between 131-190 or more than 190 respectively. Quality of surgical field was graded as Excellent, Good, Fair and Bad.
Results: A total of 116 patients were included. Mean pressure was 192.73 ± 31.73 mm Hg and mean time of ischemia was 73.92 ± 33.09 minutes. Quality of the surgical fi eld was Excellent in 84 cases (72.4 %), Good in 26 cases (22.4 %) and Fair in 6 cases (5.2 %) with no Bad cases.
Conclusions: The surgical fi eld was considered Excellent or Good in 94.8% of the cases with ankle pressures noticeably lower than those traditionally used in the ankle for foot surgery. The use of LOP method to calculate tourniquet pressures at the ankle is a valid and safe method that allow a bloodless surgical fi eld with minimal complications.



RESUMEN

Objetivos: El uso de torniquetes en cirugía del pie puede presentar complicaciones. Se valoró la calidad del campo quirúrgico exangüe y la aparición de complicaciones con el uso de torniquete localizado en el tobillo, determinando la presión mediante el método de Presión de Oclusión de Extremidad (POE).
Pacientes y métodos: Se incluyeron a pacientes intervenidos quirúrgicamente del pie con torniquete en el tobillo. La presión con método POE se determinó con manguito en el tobillo hasta que se perdía el pulso con onda doppler, y al que se añadió un margen de seguridad de 40, 60 u 80 mm Hg si el valor POE era menor de 130, entre 131-190 y mayor de 190 mm Hg, respectivamente. La calidad del campo quirúrgico fue catalogada como Excelente, Buena, Regular y Mala.
Resultados: Se incluyeron un total de 116 pacientes. La media de presión utilizada fue de 192.73 ± 31.73 mm Hg y el tiempo medio de isquemia 73.92 ± 33.09 minutos. La calidad del campo quirúrgico fue Excelente en 84 casos (72.4 %), Buena en 26 casos (22.4 %) y Regular en 6 casos (5.2 %) sin ningún caso de Mala calidad.
Conclusiones: El campo quirúrgico fue considerado como Excelente o Bueno en el 94.8 % de los casos con el uso de presiones sensiblemente inferiores a las clásicamente utilizadas en el tobillo para cirugía del pie. El cálculo de la presión del torniquete en el tobillo mediante el método POE es un método válido y fi able que permite un campo quirúrgico exangüe con mínimas complicaciones.


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Bibliografía

1. Farhan-Alanie MM, Dhaif F, Trompeter A, Underwook M, Yeung J, Parsons N, et al. The risks associated with tourniquet use in lower limb trauma surgery: a systematic review and meta-analysis. Eur J Orthop Surg & Traumatol. 2021;31(5):967-79.
2. Davey MS, Davey MG, Hurley ET, Kearns SR. Tourniquet use during open reduction and internal fixation of ankle fractures - A systematic review and meta-analysis. J Foot Ankle Surg. 2022;61(5):1103-8.
3. Singh V, Robin JX, Fieldler B, Rozell JC, Schwarzkopf R, Aggarwal VK. Tourniquet use is associated with reduced blood loss and fewer reoperations in aseptic revision total knee arthroplasty. J Arthroplasty. 2022;37(8S):S947-S953.
4. McEwen JA. Complications of and improvements in pneumatic tourniquets used in surgery. Med Instrum. 1981;15(4):253-7.
5. Odinsson A, Finsen V. Tourniquet use and its complications in Norway. J Bone Joint Surg Br Vol. 2006;88(8):1090-2.
6. Committee on Complications of Arthroscopy, Association of North America. Complications of arthroscopy and arthroscopic surgery: results of a national survey. Arthroscopy. 1985;1(4):214-20.
7. Pennsylvania Patient Safety Authority. Strategies for avoid problems with the use of pneumatic tourniquets. Pennsylvania Patient Safety Advisory. 2010;7(3):97-101.
8. Ahmed I, Chawla A, Underwood M, Price AJ, Metcalfe A, Hutchinson C, et al. Tourniquet use for knee replacement surgery. Cochr Database System Rev. 2020;12:CD012874.
9. Migliorini F, Maffulli N, Eschweiler J, Knobe M, Tingart M, Betsch M. Tourniquet use during knee arthroplasty: A Bayesian network meta-analysis on pain, function, and thromboembolism. Surgeon. 2022;20(4):241-51.
10. Fitzgibbons PG, DiGiovanni C, Hares S, Akelman E. Safe Tourniquet Use: A Review of the Evidence. J Am Acad Orthop Surg. 2012;20(5):310-9.
11. Noordin S, McEwen JA, KraghCJF, Eisen A, Masri B. Surgical Tourniquets in Orthopaedics. J Bone Joint Surg (Am). 2009;91(12):2958-67.
12. AORN: Recommended practices for the use of the pneumatic tourniquet in the perioperative practice setting. In: Blanchard J, Burlingame B (eds.). Perioperative Standards and Recommended Practices: For Inpatient and Ambulatory Settings. Denver, Colorado: Association of periOperative Registered Nurses; 2011. p. 177-89.
13. Association of Surgical Technologists: Recommended Standards of Practice for Safe Use of Pneumatic Tourniquets [Internet]. Littleton, CO, Association of Surgical Technologists; 2007 [Acceso en marzo de 2023]. Disponible en: http://www.ast.org//pdf/Standards_of_Practice/RSOP_Pneumatic_Tourniquets.pdf.
14. McEwen JA, Inkpen K, Younger A. Thight tourniquet safety. Surgical Technologist. 2002;34(7):9-19.
15. Tuncali B, Karci A, Bacakoglu AK, Tuncali BE, Ekin A. Controlled hypotension and minimal inflation pressure: a new approach for pneumatic tourniquet application in upper limb surgery. Anesth Analg. 2003;97(5):1529-32.
16. Tuncali B, Boya H, Kaykan Z, Arac S. Tourniquet pressure settings based on limb occlusion pressure determination or arterial occlusion pressure estimation in total knee arthroplasty? A prospective, randomized, double blind trial. Acta Orthop Traumatol Turc. 2018;52(4):256-60.
17. Younger ASE, McEwen JA. Inkpen K. Wide Contoured Thigh Cuffs and Automated Limb Occlusion Measurement Allow Lower Tourniquet Pressures. Clin Orthop Rel Res. 2004;428:286-93.
18. Reilly CW, McEwen JA, Leveille L, Perdios A, Mulpuri K. Minimizing Tourniquet Pressure in Pediatric Anterior Cruciate Ligament Reconstructuve Surgery: A Blinded, Prospective Randomized Controlled Trial. J Pediatr Orthop. 2009;29(3):275-80.
19. Pauers RS, Carocci M. A low pressure pneumatic tourniquets: Effectiveness at minimum recommended inflation pressures. J Foot Ankle Surg. 1994;33(6):605-9.
20. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573-7.
21. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2(5920):656-9.
22. Sarrafian SK, Kellikian AS. Angiology. En: Kellikian AS (ed.). Sarrafian’s anatomy of the foot and ankle: descriptivie, topografphical, functional. 3.ª ed. Philadelphia: Walters Kluwer Lippincott Williams & Wilkins; 2011. p. 381-427.
23. Masri BA, Eisen A, Duncan CP, McEwen JA. Tourniquet-induced nerve compression injuries are caused by high pressure levels and gradients - a review of the evidence to guide safe surgical, pre-hospital and blood flow restriction usage. BMC Biomed Eng. 2020;2:7.
24. Hurst LN, Weiglein 0, Brown WF, Campbell G. The pneumatic tourniquet: a biomechanical and electrophysiological study. Plast Reconstr Surg. 1981;67(5):648-52.
25. Day RL, Zale BW. The effect of tourniquets on muscle enzymes during foot and ankle surgery. J Foot Surg. 1993;32(3):280-4.
26. Klenerman L. Tourniquet paralysis. J Bone Joint Surg. 1983;66(4):374-5.
27. McLaren AC, Rorabeck CH. The pressure distribution under tourniquets. J Bone Joint Surg. 1985;67(3):433-8.
28. Ochoa J, Fowler T, Gilliatt RW. Anatomical changes in peripheral nerves compressed by a pneumatic tourniquet. Anat. 1972;113(Pt 3):433-55.
29. Ochoa J, Danta G, Fowler TJ, Gilliatt RW. Nature of the nerve lesion caused by a pneumatic tourniquet. Nature. 1971;233(5317):265-6.
30. Derner R, Buckholz J. Surgical hemostasis by pneumatic ankle tourniquet during 3027 podiatric operations. J Foot Surg.1995;34(3):236-46.
31. Kim TK, Bamme AB, Sim JA, Park JH. Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial. BMC Musculoskel Dis. 2019;20(1):275.
32. Wakai A, Winter DC, Street JT, Redmond PH. Pneumatic tourniquets in extremity surgery. J Am Acad Orthop Surg. 2001;9(5):345-51.
33. Diamond EL, Sherman M, Lenet M. A quantitative method of determining the pneumatic ankle tourniquet setting. J Foot Surg. 1985;24(5):330-4.
34. Massey KA, Blakeslee C, Martin W, Pitkow HS. Pneumatic Ankle Torniquets: Physiological Factors Related to Minimal Arterial Occlusion Pressure. J Foot Ankle Surg. 1999;38(4):256-63.
35. Tuncali B, Karci A, Tuncali BE, et al. A new method for estimating arterial occlusion pressure in optimizing pneumatic tourniquet inflation pressure. Anesth Analg. 2006;102(6):1752-7.
36. Tuncali B, Boya H, Kayhan Z, Arac S, Camurdan MA. Clinical utilization of arterial occlusion pressure estimation method in lower limb surgery: effectiveness of tourniquet pressures. Acta Orthop Traumatol Turc. 2016;50(2):171-7.
37. Kamath K, Kamath SU, Tejaswi P. Incidence and factors influencing tourniquet pain. Chin J Traumatol. 2021;24(5):291-4.
38. Finsen V, Kasseth A. Tourniquets in forefoot surgery. J Bone Joint Surg. 1997;79(1):99-101.
39. Murphy CG, Winter DC, Bouchier-Hayes DJ. Tourniquet injuries: pathogenesis and modalities for attenuation. Acta Ortohop Bel. 2005;71(6):635-45.
40. Kumar K, Railton C, Tawfic Q. Tourniquet application during anesthesia: “What we need to know?”. J Anaesthesiol Clin Pharmacol. 2016;32(4):424-30.
41. Darmanis S, Papanikolaou A, Pavlakis D. Fatal intra-operative pulmonary embolism following application of an Esmarch bandage. Injury. 2002;33(9):761-4.
42. Feldman V, Biadsi A, Slavin O, Kish B, Tauber I, Nyska M, et al. Pulmonary Embolism After Application of a Sterile Elastic Exsanguination Tourniquet. Orthopedics. 2015;38(12):e1160-3.
43. Bharti N, Mahajan S. Massive pulmonary embolism leading to cardiac arrest after tourniquet deflation following lower limb surgery. Anaesth Intensive Care. 2009;37(5):867-8.
44. Song JE, Chun DH, Shin JH, Park C, Lee JY. Pulmonary thromboembolism after tourniquet inflation under spinal anesthesia - A case report-. Korean J Anesthesiol. 2010;59 Suppl(Suppl):S82-5.
45. Hanberg P, Bue M, Kabel J, Jørgensen AR, Søballe K, Stilling M. Tourniquet‐induced ischemia and reperfusion in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone . APMIS. 2021;129(4):225-31.

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Pascual Huerta J, Palacio Fernández L, Trincado Villa L, González Fernández A, Mongil Escudero E. Use of Limb Occlusion Pressure as a method for calculation of intraoperative ankle tourniquet pressure in forefoot surgery: a prospective case series. Rev Esp Pod 2024; 35(1): 4-10 / DOI: 1020986/revesppod20241676/2023


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Ficha Técnica

Recibido: 09/10/2023

Aceptado: 04/12/2023

Prepublicado: 17/04/2024

Publicado: 28/06/2024

Tiempo de revisión del artículo: 55 días

Tiempo de prepublicación: 191 días

Tiempo de edición del artículo: 263 días


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2024 Revista Española de Podología
ISSN: 0210-1238   e-ISSN: 2695-463X

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