Wet or dry? Tourniquet use in fibula free flap harvest

Abstract

Introduction: Free flap harvesting from the limbs is conventionally done under tourniquet control for the advantages of a clean surgical field and the easy identification of anatomical structures, allowing rapid flap harvesting while minimizing blood loss. However tourniquet application is not entirely benign and complications of tourniquet use in limbs is well documented. It is our observation that the initial dry field is more than offset by the significant bleeding at the time of tourniquet release, while subjecting the flap to an additional ischaemia-reperfusion episode.