What Is A Tourniquet?

A tourniquet is something used to cut off the blood to a tissue.  Anything that accomplishes this goal could be considered a tourniquet.  A belt applied to a leg could act as a tourniquet.  A rubber band applied to a finger could be considered a tourniquet.  

While simple tight elastic bandages can be used for a tourniquet, more typically a cuff is applied and a machine is used to tighten a cuff and stop blood flow.   In the foot, most podiatric physicians will apply two times the systolic blood pressure to cut off the blood flow to the foot and leg. 

Why Are Tourniquets Used?   

Most tourniquets are used during surgical procedures, where there is a perceived need to cut down on blood flow to the tissues.  Many doctors feel that tourniquets keep the surgical field cleaner (less bloody), and so they can perform the surgery faster and more efficiently, which means less stress to the patient. 

What Are The Disadvantages Of Using A Tourniquet?

• Tourniquets can be uncomfortable.

• By compressing the circulation for long periods of time, tourniquets can cause tissue damage to the circulation and, really, all other tissues because all tissues depend upon that circulation.  Even in healthy patients, tourniquets are usually left on no more than 2 hours at a time to protect tissues from circulatory damage.  

• Loss of sensation after the procedure from compression on the nerves.  

When Are Tourniquets Used?

It is really up to the physician to decide when to  use tourniquets.  Many doctors use tourniquets on the majority of their podiatric surgical cases. 

For most foot surgeries we perform at the Achilles Foot Health Clinic and Surgical Centre, we rarely use tourniquets.  We find that tourniquets create unnecessary tissue damage, and if the surgical dissection is performed carefully, the surgical field can be maintained free of blood in the vast majority of circumstances.  Finally, we prefer to see if there is a bleeding vessel during the surgery, and deal with it during the procedure. 

When Should Tourniquets Not Be Used?

Tourniquets are more likely to be avoided in these cases: 

• In the diabetic patient.  (Tourniquets create unnecessary damage to tissues and vascular structures.)

• In the patient with severe hypertension--i.e., patients with high blood pressure.  (Tourniquets raise the body's blood pressure.)

• In anyone with poor circulation.   (Tourniquets create unnecessary damage to tissues and vascular structures.)

• In cases of trauma (Tourniquets simply create additional trauma for the tissues.)

• In patients with sickle cell disease.  (Tourniquets could create a sickle cell crisis.)

• In patients with an arterial graft.  (Tourniquets could damage the graft.)

• In patients with skin grafts.  (All bleeding points must be identified.)

If you are having surgery and you have any of these conditions, you may wish to discuss with your physician whether he or she plans to use a tourniquet during the procedure.