Surgical tourniquet burns: a preventable injury

Dr Qadir Khan1, Dr Edward Siddens1, Prof Fiona Wood1

1Fiona Stanley Hospital

Abstract:

Background:

The use of pneumatic tourniquets is very common in extremity surgery. There are complications associated with its use e.g. swelling, neurapraxia, vascular injury, compartment syndrome and burns. These can be prevented by taking a few simple measures.

Method:

We report 2 cases of tourniquet associated burn. A 25 year old female underwent anterior cruciate ligament reconstruction. The surgery was performed under tourniquet control for 2 hours. An area of full thickness burn at the site of the tourniquet was noticed post-op.

The second patient was a 42 year old female who had an elective orthopaedic procedure on her elbow under tourniquet control. A mixed full/partial thickness burn was seen at the tourniquet site on removal of the plaster cast post-operatively. Details of the skin preparation and tourniquet inflation time were not available to the authors.

Results:

Both patients had a delay in referral to our unit. They had debridement with Split Skin Grafts and Recell (autologous non-cultured skin cells). The grafts had fully taken on post-op follow-up reviews.

Discussion

Chemical burns secondary to tourniquets are associated mainly with alcohol based skin preparations. But there have been reports of burns associated with chlorhexidine-Gluconate¹⁰ and 5% aqueous Povidone-Iodine¹². We suggest a few simple measures to prevent tourniquet associated burns. These include the use of padding under tourniquets, water proof occlusive dressing to seal off the tourniquet, avoid pooling of skin prep around the tourniquet, inspection of tourniquet site post-op and early referral to a specialist centre in case of a burn.

References:

  1. Hodgkinson, Darryl J., George B. Irons, and Tiffany J. Williams. “Chemical burns and skin preparation solutions.” Surgery, gynecology & obstetrics4 (1978): 534-536.
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  10. Hodgins, Justin, et al. “Chlorhexidine-Gluconate-Related Burns Under a Tourniquet.” JBJS Case Connector2 (2012): e27.
  11. Krishna, Loveneesh G., et al. “Unusual complication of pneumatic tourniquet-chemical burn.” Injury Extra3 (2012): 21-24.
  12. Supradeeptha, Challa, et al. “Aqueous based Povidone-iodine related chemical burn under the tourniquet (a case report) and literature review.” Journal of orthopaedics3 (2013): 152-154.
  13. Ellanti, Prasad, and Conor Hurson. “Tourniquet-associated povidone-iodine-induced chemical burns.” BMJ case reports 2015 (2015): bcr2014208967.

Biography:


I am a Plastic & Reconstructive Surgery SET IV trainee registrar in Perth, Western Australia. I went to medical school in Pakistan after which I went to the UK. I worked as Senior House Officer in General Surgery and successfully took the MRCS exam. I then  moved to Australia where I developed interest in Plastic Surgery. I have presented at various state, national and international conferences and published in the European Journal of Plastic Surgery.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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