12/3/2023 0 Comments Blood restriction therapy![]() ![]() An exception to this progression in safety was evident from the introduction of a non-pneumatic elastic tourniquet ring which produced high pressure gradients and uncontrolled applied pressure levels, resulting in reports of nerve injuries and pulmonary embolism. However, progressions in recent generations of pneumatic tourniquet technology, highlighted by advances in personalized tourniquets, have substantially reduced the frequency and severity of such injuries. Reports of limb paralysis, serious nerve damage, and a range of other injuries were common with early generations of tourniquets. Generations of tourniquet technology have evolved over time, from simple cloth bands tied tightly around limbs, to mechanical screw tourniquets, to elastic, non-pneumatic Esmarch tourniquets, and most recently to the current generation of microprocessor controlled pneumatic tourniquets first conceived and developed by McEwen in 1981. Tourniquets have been used for centuries to occlude arterial flow distal to the device to control extremity bleeding and provide a clearer surgical field. Key risks, hazards, and mechanisms of injury for surgical, BFR therapy, and pre-hospital tourniquet use are identified, and a description is given of how advances in personalized tourniquet systems have reduced tourniquet-related injuries in these broader settings, increasing patient safety and how these advances are improving treatment outcomes. BFR therapy when appropriately prescribed can augment a surgeon’s treatment plan, improving patient outcomes and reducing recovery time. Recent evidence supports the application of tourniquets for blood flow restriction (BFR) therapy to reduce muscular atrophy, increase muscle strength, and stimulate bone growth. Short-term use of pre-hospital tourniquets is effective in preventing life-threatening blood loss, but a better understanding of the differences between tourniquets designed for pre-hospital vs surgical use will provide a framework around which to develop guidelines for admitting to hospital individuals with pre-applied tourniquets. Advances in safety, accuracy and reliability of surgical tourniquet systems have reduced nerve-related injuries by reducing pressure levels and pressure gradients, but that may have resulted in reduced awareness of potential injury mechanisms. ![]() Tourniquets can result in temporary or permanent injury to underlying nerves, muscles, blood vessels and soft tissues. Tourniquets in orthopaedic surgery safely provide blood free surgical fields, but their use is not without risk. ![]()
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