Ring Tourniquet Research Articles

Sterile Silicone Ring Tourniquets in Limb Surgery: A Prospective Clinical Trial in Pediatric Patients Undergoing Orthopedic Surgery.

Sterile silicone ring tourniquets (SSRTs) reduce intraoperative bleeding and provide a wide surgical view. Moreover, they reduce the risk of contamination and are cheaper than conventional pneumatic tourniquets. Our study describes the perioperative outcomes of sterile silicone ring tourniquet placement in pediatric patients undergoing orthopedic surgery. We prospectively recruited 27 pediatric patients aged < 18 years who underwent 30 orthopedic surgeries between March and September 2021. Following complete surgical draping, all operations were initiated by placing SSRTs. We investigated the demographic and clinical characteristics of these patients, details of the tourniquet used, and intra- and postoperative outcomes of tourniquet placement. Owing to the narrowness of tourniquet bands and tourniquet placement at the proximal ends of the extremities, wide surgical fields were achieved, without limiting joint range of motion. Bleeding control was effective. Tourniquets were applied and removed rapidly and safely, regardless of limb circumference. None of the patients experienced postoperative pain, paresthesia, skin problems at the application site, surgical site infections, ischemic problems, or deep vein thrombosis. SSRTs effectively reduced intraoperative blood loss and facilitated wide operative fields in pediatric patients with various limb sizes. These tourniquets allow quick, safe, and effective orthopedic surgery for pediatric patients.

A Case Report of Ring Tourniquet Syndrome: A Paradigm of Danger

Ring Tourniquet Syndrome (RTS) is a rare but potentially serious condition that occurs when a small, tight object such as a hair, thread, or string becomes wrapped around a finger, toe, or other body part, creating a tourniquet-like effect. This can lead to tissue damage, swelling, a bluish colour of the finger, and in severe cases, loss of the affected digit or limb. Here, we present a case of an 11-year-old female patient who was diagnosed with RTS due to a metallic latch on the left index finger. The patient was managed with the removal of the latch under local anaesthesia in the operating theatre and regained full range of motion without any signs of ischemia on a 2-week follow-up. This case report highlights the successful salvage of a finger affected by RTS through prompt recognition and appropriate intervention.

1345 A Punch Above the Rest: A High Yield Modification of The Diagnostic Nailbed Biopsy

Abstract Aim Diagnostic nailbed biopsy is indicated for pathology including malignancy, persistent and suspected mycomial infection and rheumatological disease. Operatively, the challenge resides in establishing an equilibrium between harvesting ample histological sample for diagnostic value without the creation of a functionally and aesthetically unacceptable nail due to significant disruption of the nailbed. We illustrate a simple and reproducible biopsy technique through one small forgiving defect without disruption of surrounding soft tissue. Method The procedure is carried out under normal sterile conditions with local anaesthetic and a ring tourniquet. A 5mm punch biopsy is taken of the nail, adjacent to the eponychium, followed by a 4mm punch biopsy of the underlying nailbed at a 45-degree angle. The subungual surface of the nail is tangentially transected generating a mycomial sample and the nailbed is sent for histology. The remaining nail is replaced if not required for histology, and cyanoacrylate glue applied followed by a finger dressing. Results Figures show an example of how the nail biopsy is carried out. Biopsy sample and the resulting defect in the nail is also displayed. Conclusions The double punch technique reliably harvests adequate diagnostic specimens through one wound, without the disruption of adjacent nail plate, nailbed and perionychium. This is even more a priority when histology identifies no pathology requiring further operative resection. Whilst the nail undergoes its normal growth cycle post-operatively, aesthetically, the fingertip does not draw undue patient dissatisfaction once the dressing is removed in comparison to alternative biopsy techniques.

Single sterile silicon ring technique for utilization of upper limb intravenous regional anesthesia: A prospective study of patients with operated distal radius fractures

IntroductionIntravenous regional anesthesia is a well-established method of anesthesia in upper extremity surgery. In this study, we present a modification of the technique using a silicon ring tourniquet in 30 patients undergoing internal fixation for distal radius fractures. MethodsA sterile silicone ring wrapped within a stockinette sleeve was applied, and a local anesthetic solution (3 mg/kg lidocaine 0,5%) was injected intravenously. After anesthesia onset, the ring was rolled distally to provide immediate pain and discomfort relief. ResultsThe silicone ring achieved adequate exsanguination in all patients. Mean pain VAS score was 2.7 ± 0.9 intraoperatively and 4.3 ± 1.3 during the first hour postoperatively. The onset and termination times of sensory block were 5.8 ± 2.1 and 102 ± 7.8 min, and of motor block 13.8 ± 2.8 and 54.2 ± 4.6 min, accordingly. All patients were satisfied from the procedure. ConclusionSterile silicone ring tourniquet application is a simple, safe and effective analgesic and anesthetic technique for the operative treatment of distal radius fractures.

Comparison of local pain and tissue reaction between conventional pneumatic tourniquet and disposable silicone ring tourniquet during Total Knee Arthroplasty

BackgroundTo study the comparison of conventional pneumatic and disposable silicone ring tourniquet in Total Knee Arthroplasty. Material and methodsThis is a prospective randomized control trial. We used conventional pneumatic tourniquet on one side of leg and disposable silicone ring tourniquet on the other side in consecutive 50 simultaneous bilateral TKR patients. Patients having peripheral vascular disease of the lower limb were excluded from the study. The patient demographics & characteristics are identical being the same patient with two different legs. We started the study with null hypothesis. An independent observer assessed the local tourniquet site pain (VAS score 1–10) and local tourniquet site skin reaction at 24 h and 48 h after the TKA. P value < 0.05 was considered significant. ResultsThere were no local skin complication with disposable tourniquet (0%). 8 out of 50 patients in whom the conventional tourniquet was applied showed local bruising, and two patients had blister formation making the local skin site complication rate 20% (statistically significant, p value0.0196, chi-squared test). The VAS score at 24 h was 4.3 ± 1.5 for disposable tourniquet group as against 5.6 ± 2.1 for conventional tourniquet group (statistically significant, p value = 0.0152, t statistic test for comparison of means). The VAS score at 48 h was 2.1 ± 1.5 and 3.3 ± 1.2 for disposable tourniquet group and conventional tourniquet group respectively (statistically significant p value = 0.003, student’s t-test). ConclusionUse of disposable tourniquet has better outcome than the conventional tourniquet with minimal or no local complications. The advantages of the disposable tourniquet are: 1 less local pain, 2. no local skin problems, 3. accurate tourniquet pressure at the application site, 4.0% local contamination. Hence, we recommend use of the disposable tourniquet during the Total Knee Arthroplasty.

Does the Use of a Silicone Ring Tourniquet Help Reduce Bleeding in the Minimally Invasive Internal Fixation with Locking Plate for Distal Femoral Fractures?

Does the Use of a Silicone Ring Tourniquet Help Reduce Bleeding in the Minimally Invasive Internal Fixation with Locking Plate for Distal Femoral Fractures?

Resolution of Ring Tourniquet with a High-speed Dental Drill in a Remote Pacific Island Clinic

Ring tourniquet syndrome is a strangulation injury, usually at the proximal finger or toe, caused by a rigid circular metal object. The resulting ischemia can lead to necrosis, permanent nerve and/or tissue damage, and amputation of the digit. There are numerous non-cutting methods for removing the ring; however, edema, fractures, or arthrosis of the site can occasionally make these techniques difficult or impossible. While ring cutters, manual or electric, are the first choice for resolving ring tourniquet caused by metal jewelry, these tools are not readily available everywhere. Resolution of ring tourniquet with high-speed rotary tools has been previously described as a tertiary method. Here we describe the use of a high-speed dental tool as a primary ring cutting method for the resolution of ring tourniquet in a patient with significant edema in a low-resource setting.

Silicone ring tourniquet versus pneumatic cuff tourniquet in total knee arthroplasty surgery: A randomised comparative study

IntroductionThe aim of the present study was to compare a silicone ring tourniquet (SRT) and a classic pneumatic cuff tourniquet (PT) in patients undergoing total knee replacement. We have compared the impact on the glycolytic activity caused by the ischaemia applied to the limb during the surgery. Material and methods140 patients that underwent total knee arthroplasty (TKA) were randomised in two groups. Serum lactate determination was made by reactive strips of enzymatic-amperometric detection, 5 min before tourniquet application and 5 min after tourniquet removal. ResultsThe mean tourniquet time was similar for both groups (p 0.13). Postoperative serum lactate levels were higher with statistical significance than the preoperative levels and with a positive Pearson´s correlation in the overall cases. The postoperative serum lactate levels where higher in the PT group (4.097 ± 2.248 mmol/L) than the SRT group (3.499 ± 1.566 mmol/L). There was no significant difference (p 0.07) to be able to affirm that there was a difference of the anaerobic metabolism according to the tourniquet system used. DiscussionIschaemia applied to the lower extremity during knee replacement surgery can produce tissue injury. Serum lactate determination allows comparison of the ischaemic changes during TKA surgery caused by two different tourniquet systems. ConclusionsSRT may be not disadvantageous compared to the classic PT from the impact on the glycolytic activity caused by the ischaemia.Level of evidence II.

Silicone ring tourniquet or pneumatic cuff tourniquet for total knee arthroplasty.

The goal of the present study was to evaluate the potential advantages of a silicon ring tourniquet in comparison to the conventional pneumatic cuff tourniquet. The tested hypothesis was that the calculated blood loss will be decreased after use of the silicone ring tourniquet. The study was monocentric and mixed retrospective and prospective evaluation of prospectively collected data. Inclusion criterion was implantation of a total knee arthroplasty. The retrospective control group involved 39 patients operated on with a pneumatic cuff tourniquet. The prospective study group involved 33 patients operated on with a silicone ring tourniquet. All patients were followed for threemonths. Primary criterion was the calculated blood loss (OSTHEO formula). Secondary criteria were pain on third post-op day, need for allogenic transfusion, haemoglobin drop, delay of discharge, and occurrence of complications. The mean calculated blood loss was 901ml in the study group and 989ml in the control group (NS). There was no significant difference in pain evaluation and haemoglobin drop between the two groups. There was a non significant decrease of allogeneic transfusion and length of stay in the study group. There was a significant decrease of complication rate in the study group, and especially for skin complications. The tested hypothesis was not confirmed: there was no significant change in the calculated blood loss. No bias was identified in complication analysis. The decreased rate of skin complication might be a positive influence of the silicone ring tourniquet.

The Effect of the Silicone Ring Tourniquet and Standard Pneumatic Tourniquet on the Motor Nerve Conduction, Pain and Grip Strength in Healthy Volunteers.

The pneumatic tourniquet (PT) is routinely used in upper and lower limb operations by most orthopaedic surgeons. The silicone ring tourniquet (SRT) was introduced in clinical practice over the last decade. Clinical as well as comparative studies have been published in volunteers concerning its safety and efficacy. The aim of this study was to investigate the postoperative effect of the silicone ring tourniquet (SRT), primarily on the motor nerve conduction, and secondarily on the pain and grip strength, in comparison to the effect of the pneumatic tourniquet (PT) in healthy volunteers. Both tourniquets were applied in the forearm of the dominant arm in 20 healthy volunteers and were kept on for 10 minutes. Pain was measured using the visual analogue scale and grip strength was measured with a hand dynamometer. We evaluated the following parameters of median nerve conduction: motor conduction velocity (MCV), latency (LAT) and amplitude (AMP). Pain score at the time of tourniquet application was higher in SRT group but the alteration in pain scores in PT group was higher, with statistical significance (P<0.05). The grip strength was reduced by the application of both tourniquets; however there was a significantly higher reduction in the SRT group (P<0.05). The conduction impairment of the median nerve was worse in the PT group than in the SRT one, according to the changes in MCV (P<0.05). Median nerve conduction was affected more after PT application as compared to the SRT. Nevertheless, the reduction of grip strength was higher after the SRT application.

Acute radial nerve entrapment at the spiral groove: detection by DTI-based neurography.

This study evaluated the potential of three-tesla diffusion tensor imaging (DTI) and tractography to detect changes of the radial (RN) and median (MN) nerves during transient upper arm compression by a silicon ring tourniquet. Axial T2-weighted and DTI sequences (b = 700 s/mm(2), 16 gradient encoding directions) of 13 healthy volunteers were obtained. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the MN and RN were measured at the spiral groove and further visualized in 3D by deterministic tractography (thresholds: FA = .15, angle change = 27°). Local/lesional RN FA values increased (p = 0.001) and ADC values decreased (p = 0.02) during a 20-min upper arm compression, whereas no significant FA (p = 0.49) or ADC (p = 0.73) changes of the MN were detected. There were no T2-w nerve signal changes or alterations of nerve trajectories in 3D. Acute nerve compression of the RN leads to changes of its three-tesla DTI metrics. Peripheral nerve DTI provides non-invasive insights into the "selective" vulnerability of the RN at the spiral groove. • DTI-based neurography detects nerve changes during acute nerve compression. • Compression leads to a transient increase in local radial nerve FA values. • DTI provides insights into radial nerve vulnerability at the spiral groove.

Nerve compression and pain in human volunteers with narrow vs wide tourniquets.

To assess the clinical effects and the morphological grade of nerve compression. In a prospective single-center randomized, open study we assessed the clinical effects and the morphological grade of nerve compression during 20 min of either a silicon ring (group A) or pneumatic tourniquet (group B) placement variantly on the upper non-dominant limb in 14 healthy human volunteers. Before and during compression, the median and radial nerves were visualized in both groups by 3 Tesla MR imaging, using high resolutional (2.5 mm slice thickness) axial T2-weighted sequences. In group A, Visual analog pain scale was 5.4 ± 2.2 compared to results of group B, 2.9 ± 2.5, showing a significant difference (P = 0.028). FPS levels in group A were 2.6 ± 0.9 compared to levels in group B 1.6 ± 1, showing a significant difference (P = 0.039). Results related to measureable effect on median and radial nerve function were equal in both groups. No undue pressure signs on the skin, redness or nerve damage occurred in either group. There was no significant difference in the diameters of the nerves without and under compression in either group on T2 weighted images. Based on our results, no differences between narrow and wide tourniquets were identified. Silicon ring tourniquets can be regarded as safe for short time application.

Silicone ring tourniquet versus pneumatic cuff tourniquet in carpal tunnel release: a randomized comparative study

BackgroundThe aim of the present study was to compare the pain levels resulting from the use of a silicone ring tourniquet (SRT) to those resulting from the use of a classic pneumatic cuff tourniquet (PT) in patients undergoing carpal tunnel release under local anesthesia.Materials and methodsFifty patients that underwent carpal tunnel release under local anesthesia were randomized using the technique of stratified randomization by minimization. A forearm tourniquet was applied: a standard PT was used in 25 patients, and an SRT was used in the other 25 patients (the model of SRT used was selected according to the standard systolic blood pressure). Patient demographics and complications were recorded. Pain levels were assessed with the visual analogue scale and were recorded (a) just after tourniquet application, (b) 5 min after tourniquet application, and (c) just before tourniquet removal.ResultsThere was no statistical significant difference in patient demographics between the two groups. The mean tourniquet time was similar for both groups (p = 1.000). The difference between the mean final pain level and the mean initial pain level was statistically significant for the SRT group (p = 0.010) and highly statistically significant for the PT group (p < 0.001). The mean final pain level for the PT group was higher than that for the SRT group (p = 0.043).ConclusionsAccording to the findings of this study, in patients who underwent carpal tunnel release under local anesthesia, the pain levels at the end of the operation and those just before the removal of the tourniquet were higher in the PT group than in the SRT group of patients.

Comparison of levels of pain perceived when using pneumatic versus silicone ring tourniquets for local anaesthetic procedures of the upper limb

Comparison of levels of pain perceived when using pneumatic versus silicone ring tourniquets for local anaesthetic procedures of the upper limb

Comparison of pain perceived when using pneumatic or silicone ring tourniquets for local anaesthetic procedures in the upper limb

The aim of this study was to evaluate the level of pain felt when silicone ring and pneumatic tourniquets were applied to the upper arm and to determine which was more suitable for use in local anaesthetic procedures. Pain was measured using a visual analogue score pain scale on application and at 1, 5, and 10 minutes in 30 volunteers. Volunteers experienced significantly more pain on application and at 1 and 5 minutes with the silicone ring tourniquet. This difference in pain was most marked on application. Two volunteers could not tolerate application of the silicone ring tourniquet. We conclude that the silicone ring tourniquet would not be suitable for local anaesthetic procedures in the upper limb due to the severe pain experienced on application, which may reduce the patients' confidence and adversely affect their experience of the procedure. The pneumatic tourniquet is more suitable for local procedures.

Comparison of levels of pain perceived when using pneumatic versus silicone ring tourniquets for local anaesthetic procedures of the upper limb

Comparison of levels of pain perceived when using pneumatic versus silicone ring tourniquets for local anaesthetic procedures of the upper limb

Re: Mohan A, Baskaradas M, Solan M, Magnussen P. Pain and paraesthesia produced by silicone ring and pneumatic tourniquets. J Hand Surgery Eur. 2011, 36: 215–18

Re: Mohan A, Baskaradas M, Solan M, Magnussen P. Pain and paraesthesia produced by silicone ring and pneumatic tourniquets. J Hand Surgery Eur. 2011, 36: 215–18

Pain and paraesthesia produced by silicone ring and pneumatic tourniquets

Twenty volunteers were recruited to compare a novel, silicone ring tourniquet (the Hemaclear® tourniquet) with a pneumatic tourniquet. After application of the tourniquets, the pain and paraesthesia experienced by the participants was scored at 1 minute, 5 minutes, and 10 minutes. This was repeated with the tourniquets on the forearm. On the upper arm, the silicone ring tourniquet was associated with a significantly lower pain score than the pneumatic tourniquet. The incidence of paraesthesia was also lower with the silicone ring tourniquet. When applied to the forearm, there was no statistically significant difference in pain scores between the two types of tourniquets. However the incidence of paraesthesia was again lower with the silicone ring tourniquet.

Silicone ring versus pneumatic cuff tourniquet: a comparative quantitative study in healthy individuals

The aim of the present study was to compare a new silicone ring tourniquet (SRT) with a classic pneumatic cuff tourniquet (PT) in terms of tolerance and recovery time following their use in healthy volunteers. Both tourniquets were applied in the arm and thigh of 15 healthy unmedicated volunteers. PT pressure was kept at 100 mmHg above the systolic blood pressure. The appropriate model of the SRT was used according to the systolic blood pressure. Pain was assessed by visual analogue scale and arterial blood pressure, pulse rate and oxygen saturation were monitored in all volunteers. There was no statistically significant difference in tolerance time between SRT and PT in the arm (19.13 vs. 18.25 min) and thigh (21.52 vs. 21.39 min) nor in recovery time between the two devices. The SRT performed similarly to the classic PT in terms of tolerance and recovery time when applied in the arm and thigh of unmedicated healthy volunteers.

Analysis of an elastic ring tourniquet (ERT) using the theory of a Cosserat curve and finite elements

A-TT™ and S-MART™ are novel elastic ring tourniquets (ERTs) used for the control of hemodynamic shock and for bloodless surgical procedures on limbs. The ERT device is essentially a silicone ring surrounded by a stockinette sterile gauze. Since the contact pressure applied by the ERT is determined by its geometric and mechanical properties and cannot be adjusted, it is important to develop a mechanical model that can be used to ensure that the contact pressure remains low enough not to cause local tissue damage. Although the calculation of the contact pressure applied by a silicone ring seems to be a simple classical problem, it is shown that the accurate prediction of this contact pressure requires analysis of a number of complicating features, which are related to nonlinear geometric and material influences. This paper presents a hierarchy of mechanical models which include: a simple strength of materials model; models based on the theory of a Cosserat curve and a generalized string (which includes deformation of the cross-section); exact axisymmetric plane strain nonlinear elasticity; and axisymmetric nonlinear finite element analysis. It is shown that the Cosserat model provides reasonable predictions of the response of the silicone ring. Since numerical simulations with the Cosserat model are much faster than those with the finite element model, the Cosserat analysis is more suitable for optimization of the thickness of the stockinette, which can significantly reduce both the maximum and average contact pressures applied by the ERT on the skin.