Tourniquet Compression Research Articles

Blood-conserving and therapeutic efficacy of intravenous tranexamic acid at different time points after primary total knee arthroplasty with tourniquet application: a randomised controlled trial

BackgroundThe use of a tourniquet in combination with tranexamic acid (TXA) not only ensures clear vision, reduces intraoperative blood loss and shortens operative time but also improves cement-bone inter-digitation in total knee arthroplasty (TKA). However, there is no proof whether the blood flow blocking effect of tourniquet affects the antifibrinolytic effect of TXA, and the optimal timing of TXA administration is still unclear. Therefore, this study aims to investigate the effect of the first dose of TXA administered intravenously before tourniquet compression and release in TKA on perioperative blood loss and therapeutic efficacy in patients.MethodsIn this double-blind trial, 90 patients undergoing primary TKA were randomised into 2 groups: Group A, patients received intravenous TXA 10 min before tourniquet compression (20 mg/kg) and 3, 6 and 24 h later (10 mg/kg), and Group B, patients were treated the same as those in Group A but received intravenous TXA before tourniquet release. The primary outcomes were changes in blood loss, haemoglobin and haematocrit. Secondary outcomes included operation and tourniquet times, blood transfusion rate, subcutaneous petechiae and circumferential changes in the operated limb, visual analogue scale (VAS) score, hospital for special surgery (HSS) score, length of stay (LOS) postoperatively, complications and patient satisfaction.ResultsNo statistically significant difference was found between the 2 groups with regard to age, sex, weight, body mass index (BMI), Kellgren-Lawrence class, preoperative blood volume, preoperative laboratory values, operation and tourniquet times, transfusion rate, knee circumference, preoperative HSS, or VAS score (P:n.s.). There was no significant difference in intraoperative blood loss (IBL) (52.7 ml vs. 63.4 ml, P = 0.07), hidden blood loss (HBL) (91.4 ml vs. 119.9, P = 0.4) or total blood loss (TBL) (144.1 ml vs. 183.3 ml, P = 0.72) between Groups A and B. Haemoglobin, haematocrit and red blood cell count (RBC) dropped to a low point on postoperative day 3 and then rebounded, returning to normal levels on day 21, and the trend of change between the 2 groups was not statistically significant (P:n.s.). There was no significant difference in subcutaneous ecchymosis incidence, knee swelling rate, HSS score, VAS score, LOS postoperatively, complication rate or patient satisfaction (P:n.s.).ConclusionTXA was administered intravenously prior to tourniquet compression could effectively reduce blood loss in patients who had undergone total knee arthroplasty. However, there was no significant difference in knee swelling rate, subcutaneous bruising and petechiae incidence, knee function, complication rate or satisfaction between patients who TXA was given intravenously before tourniquet compression and release in primary TKA.

Use Your Noodle to Simulate Tourniquet Use on a Limb With and Without Bone.

The purpose of this study was to simulate first aid by mechanical use of a limb tourniquet on a thigh with and without bone to better understand best caregiving practices. Two investigators studied simulated first aid on a new pool "noodle," a plastic cylinder with a central air tunnel into which we inserted a wood dowel to simulate bone. Data were gathered by group (study and control, n = 12 each). The control group comprised data collected from simulated tourniquet use on the model with bone present. The study group comprised data from simulated tourniquet use on the model without bone. Comparing compression with and without bone, the mean volumes of compressed soft tissues alone were 303mL and 306mL, respectively. When bone was present, the volume of soft tissues was squeezed more, yielding a smaller size by 3mL (1%). The bone had a volume of 41mL and pressed statically outward with an equal force oppositely directed to the inward compression of the overlying soft tissues. With bone removed and compression applied, the mean residual void was 16mL, because 25mL (i.e., 41mL minus 16mL) of soft tissues had collapsed inward. The volume of the limb under the tourniquet with and without bone was 344mL and 322mL, respectively. The collapse volume, 25mL, was 3mL more than the difference of the mean volume of the limb under the tourniquet. More limb squeeze (22mL) looked like better compression, but it was actually worse-an illusion created by collapse of the hidden void. In simulated first aid, mechanical modeling demonstrated how tourniquet compression applied to a limb squeezed the soft tissues better when underlying bone was present. Bone loss altered the compression profile and may complicate control of bleeding in care. This knowledge, its depiction, and its demonstration may inform first-aid instructors.

Labetalol Hypotensive Anesthetic Protocol paves the way to Safe Open Abdominal Myomectomy: Comparative study versus Tourniquet Hemostasis

Study Hypothesis: Hypotensive protocol consisted of oral labetalol pre-medication and low-dose intraoperative (I0) labetalol infusion can improve surgical outcome of open abdominal myomectomy (OAM) than JO tourniquet compression.Study Design: Eighty-six women were randomly allocated into two equal groups: control group received normotensive anesthesia with application of uterine tourniquet for JO hemostasis and study group included patients followed the hypotensive protocol till completion of myomectomy. Surgical and anesthetic outcomes and surgeons' satisfaction were determined.Results: Three study patients required tourniquet application for control of bleeding. In study patients, mean field visibility score was non-significantly higher, but operative time, JO blood loss and need for transfusion were significantly lower and JO urine output was significantly higher. PO hemoglobin deficit was significantly lower. Hypotensive protocol allowed significant blunting of pressor reflexes to tracheal intubation and extubation and maintained non-singificant variations of heart rate (HR) and mean arterial pressure (MAP) measures during myomectomy. Postoperative HR and MAP measures were significantly lower in study patients compared to their baseline and to PO measures in patients of control group till 6-hr PO. Frequency of patients developed PO bleeding and hospital stay was significantly lower in study group. Surgeons' satisfaction by hypotensive anesthesia for OAM was non-significantly higher than by tourniquet hemostasis.Conclusion: Hypotensive anesthesia using oral labetalol pre-medication and low-dose JO labetalol infusion significantly reduced HR and MAP till immediate PO period versus classic JO tourniquet compression. Proper hemodynamic control significantly reduced open myomectomy associated bleeding complications, improved field visibility and so allowed perfect hemostasis within significantly shorter operative time than with tourniquet control of hemostasis.

Concerns with the methodology, analysis and discussion of the Buzzy® and transillumination comparison article.

Concerns with the methodology, analysis and discussion of the Buzzy® and transillumination comparison article.

Case Scenario: Postoperative Brachial Plexopathy Associated with Infraclavicular Brachial Plexus Blockade

Case Scenario: Postoperative Brachial Plexopathy Associated with Infraclavicular Brachial Plexus Blockade

HUGE HAEMATOMA CAUSING CHEST WALL COMPRESSION FROM RUPTURE OF ARTERIOVENOUS FISTULA

A 71-year-old man was transferred from a local hospital to our emergency department due to rapid swelling of his left forearm, arm, and chest wall down to the left upper quadrant of his abdomen. He had a history of diabetes mellitus and hypertension and started peritoneal dialysis for end-stage renal disease 1 year before. A left arm brachio-basilic arteriovenous fistula (AVF) was constructed due to poor peritoneal dialysis ultrafiltration efficacy 10 months later, and he just underwent cannulation before transfer. At arrival, hypotension (78/46) and tachycardia (120) were found. Physical examination showed extreme bulging of the left chest wall and asymmetric arm size. Laboratory study showed a drop in haemoglobin from his baseline level 9.0 g/dL to 6.4 g/dL. Aggressive component therapy and tourniquet compression over the puncture site were immediately applied. An extremity and chest CT showed a huge haematoma extending from the left arm to the axilla and left chest wall, resulting from the left arm AVF rupture (Fig. 1). The haematoma gradually stabilized in size after tourniquet compression, with careful distal limb pulsation monitoring. His hypotension also improved, and the swelling resolved one week later without invasive intervention. AVF rupture is a rare complication during routine cannulation of haemodialysis access, and incidence of rupture requiring surgical intervention is estimated at 1.1% (1). Causes of rupture usually involve endovascular manipulation (2), inappropriate insertion technique, and an underlying access infection or pseudo-aneurysm should always be considered, especially preceded by the “herald bleeding”. In our patient, such anatomic defect was not identified, but it is very rare that this haematoma expanded so broadly as to compromise his haemodynamic status. Peri-procedural AVF rupture is usually managed with immediate balloon tamponade or stent grafting, and conservative management has not been reported before. However, in this patient, such management turned out to be useful when instituted early in the course. If cautiously applied, a tourniquet compression for AVF rupture haemostasis could be an effective on-site management if angiographic suite or surgical service is not immediately available. REFERENCES

The effect of tourniquet compression on axonal transport in sciatic nerve of rats

Objective To investigate the effect of tourniquet compression on axonal transport in sciatic nerve of rats.Methods Twenty-four 12-week old male SD rats weighing 250-300 g were randomly divided into 4groups according to the duration of tourniquet compression(n=6 each):1,2,4 and 12 h.The tourniquet was applied to the middle 1/3 of thigh.In each animal whether the left or right thigh was compressed was determined by a flip of coin.The tourniquet was released for 10 min after every hour of compression.A 3-cm segment of sciatic nerve was removed at the end of tourniquet compression(1.5 cm proximal and 1.5 cm distal to the site of compression).Immuno-histochemistry was used to measure the expression of insulin-like growth factor-1(IGF-1)in the sciatic nerve.The ratio of average optic density of the compressed sciatic nerve to that of control was used to estimate the degree of IGF-1 accumulation.The regression equation of the interaction between the duration of compression and accumulation of IGF-1 was analyzed.Results There was significant accumulation of IGF-1 in the sciatic nerve proximal to the compressed site.The accumulation increased with the duration of compression.There was no significant accumulation of IGF-1 in the sciatic nerve distal to the compressed site.The regression equation of the interaction between the duration of compression(X)and accumulation of IGF-1(Y)was Y=0.422X+0.887.Conclusion Tourniquet compression of sciatic nerve can inhibit axonal transport.The accumulation increases with the duration of compression. Key words: Tourniquets; Axonal transport; Sciatic nerve

Experimental study of prognosis of chronic compartment syndrome

There is little in the literature concerning the pathobiology and repair processes of impaired skeletal muscle after decompressive operation for chronic compartment syndrome (CCS), which would be valuable for prognosis. Repeated tourniquet compression through cuff inflation on rabbits' claves was performed daily for 2 hr, then stopped for 30 min, and applied for another 2 hr. The contralateral hindlimb, which was not compressed, served as a control. Rabbits were allocated to four groups: groups I and II were pressured with 80 and 120 mmHg for 3 days, and groups III and IV were pressured with 80 and 120 mmHg for 14 days. Skeletal muscle specimens from each group were obtained for histological and ultrastructural observation at day 1, 7, 14, and 28 post-compression. In groups I and II, a few necrotic fibers were observed and basal lamina was intact at 1 day after compression. Seven days after compression, there was an observable increase in the proliferation of satellite cells and development of myotube structures. Fourteen days after compression, regeneration of muscles was complete, and there was no significant difference compared with the control group. In groups III and IV, 1 day post-compression examination revealed a large area of necrotic fibers, fibrotic interstitium, and disintegratin basal lamina. Seven days later, proliferation of satellite cells was observed around the surviving basal lamina, and 28 days after compression we could see a large area of fibrosis. The degree of recovery of impaired muscle in rabbit's CCS-induced tissues is related to pressure and duration of compression. Complete recovery of the impaired muscle is determined by survival of basal lamina.

Anaesthesia of the axillary plexus induces rapid improvement of sensory function in the contralateral hand: An effect of interhemispheric plasticity

Acute improvement of sensory functions in the contralateral hand during experimental, tourniquet-induced anaesthesia has been described. Tourniquet compression over an extended time period, however, may be painful - which may influence the result. To study the effects of deafferentation of the upper extremity with the pain factor eliminated, we investigated 100 patients with anaesthetised axillary plexus for perception of touch and tactile discrimination in the contralateral (unanaesthetised) hand. Anaesthesia induced a rapid, significant, improvement in tactile discrimination in the contralateral hand, compared with before anaesthesia, measured as two-point discrimination (p=0.0001), and perception of touch, measured with Semmes-Weinstein monofilament (p=0.0005). The improvement lasted as long as the arm was anaesthetised. Understanding the mechanisms of brain plasticity, including interhemispheric plasticity, is essential for designing appropriate strategies for upregulation and downregulation of cortical reorganisational changes to promote sensory relearning after nerve injury.

Electrophysiologic testing for the diagnosis of peripheral nerve injuries.

ANESTHESIOLOGISTS have an important role in preventing perioperative nerve injury, monitoring nerve function to minimize damage, and diagnosing peripheral nerve lesions at an early stage to optimize their management. The purpose of the current article is therefore to clarify the use and limitations of electrophysiologic testing in the diagnosis and management of anesthesiarelated nerve injuries. The occurrence of perioperative nerve injuries is well described. In the American Society of Anesthesiologists Closed Claims Database (a standardized collection of case summaries from the closed malpractice claims of a number of insurance companies), 16% of the 4,183 claims have been for anesthesia-related nerve injury. 1 Regional nerve block may lead to a focal nerve deficit. During surgery itself, direct injury or tourniquet compression to insure a bloodless field may be responsible. In rare instances, the compression is seemingly innocuous, as from a blood pressure cuff that inflates automatically at periodic intervals. 2 Malpositioning of patients during surgery may lead to com

Hemolysis in Serum Samples Drawn by Emergency Department Personnel versus Laboratory Phlebotomists

found when the following parameters were compared: distal arm draw versus antecubital fossa draw (P=0.0054), 22 gauge plastic cannula versus 20 gauge cannula (P=0.0104), less than half-full tube draw versus greater than or equal half-full tube draw (P=0.0159), tourniquet compression time of greater than 2 minutes versus less than or equal 2 minutes (P=0.016), and plastic versus metal cannulas ( P=0.0164). Logistic regression of these data to control for confounding variables demonstrated that the following factors contributed most to causing mechanical hemolysis: drawing from a vein in the distal arm and drawing through a narrower gauge needle. Use of a standardized protocol for blood drawing can reduce the rate of pre-analytic hemolysis by more than 7-fold. Drawing blood from the antecu

Tourniquet compression: a non-invasive method to enhance nerve regeneration in nerve grafts.

One hindlimb of a rat was subjected to tourniquet compression (150, 200 and 300 mmHg; 2 h). After 6 days a 10 mm sciatic or tibial nerve graft from the compressed limb was sutured to bridge a 3-4 mm gap in the sciatic nerve of the non-compressed limb. The distances of regenerating sensory axons were measured 6 days post surgery (tibial grafts, 8 days). Compression at 200 and 300 mmHg led to significantly longer regeneration distances than those seen in controls. Incorporation of BrdU and expression of p75 receptor by non-neuronal cells (Schwann cells) in sciatic nerves 6 days after compression (150 and 300 mmHg; 2 h) was also increased as a sign of Schwann cell activation. Tourniquet compression may be used as a non-invasive method to enhance nerve regeneration in nerve grafts.

C-terminal flanking peptide of neuropeptide Y in DRG following nerve compression.

The C-terminal flanking peptide of neuropeptide Y (CPON) was studied in dorsal root ganglia (DRG) by immunocytochemistry after different recovery periods (3, 6,14 and 28 days) following tourniquet compression of the rat hindlimb (sciatic nerve; 150 or 300 mmHg; 2 h). Compression induced a transient increase in the number of CPON-positive DRG-neurons (the contralateral uninjured side was devoid of CPON-positive cells). The compression-induced increase in CPON was less than that observed in separate rats subjected to sciatic nerve transection. The results show that compression induces regenerative changes in peripheral neurons and that such an injury of the nerve trunk is not limited to the site of the compression but results in the activation of the entire neuron.

NERVE REGENERATION ENHANCEMENT BY TOURNIQUET

The use of tourniquet compression as a non-invasive method to enhance axonal regeneration was assessed in the rat sciatic nerve. One hind limb of the rat was subjected to compression by a tourniquet set at 300 mmHg for 30 or 120 min followed by bilateral test crush lesions performed either directly or after a conditioning interval of 3 or 6 days, with the non-compressed side serving as a control. Axonal regeneration distances were evaluated after 3 days by the pinch reflex test. We found that compression caused an increased outgrowth length of sensory axons compared to the controls. The effect was most obvious after 120 min of compression with a conditioning interval of 6 days. Tourniquet compression has a conditioning lesion effect on peripheral nerve and may enhance nerve regeneration.

Ischemia causes muscle fatigue

The purpose of this investigation was to determine whether ischemia, which reduces oxygenation in the extensor carpi radialis (ECR) muscle, causes a reduction in muscle force production. In eight subjects, muscle oxygenation (TO 2) of the right ECR was measured noninvasively and continuously using near infrared spectroscopy (NIRS) while muscle twitch force was elicited by transcutaneous electrical stimulation (1 Hz, 0.1 ms). Baseline measurements of blood volume, muscle oxygenation and twitch force were recorded continuously, then a tourniquet on the upper arm was inflated to one of five different pressure levels: 20, 40, 60 mm Hg (randomized order) and diastolic (69 ± 9.8 mm Hg) and systolic (106 ± 12.8 mm Hg) blood pressures. Each pressure level was maintained for 3–5 min, and was followed by a recovery period sufficient to allow measurements to return to baseline. For each respective tourniquet pressure level, mean TO 2 decreased from resting baseline (100% TO 2) to 99 ± 1.2% (SEM), 96 ± 1.9%, 93 ± 2.8%, 90 ± 2.5%, and 86 ± 2.7%, and mean twitch force decreased from resting baseline (100% force) to 99 ± 0.7% (SEM), 96 ± 2.7%, 93 ± 3.1%, 88 ± 3.2%, and 86 ± 2.6%. Muscle oxygenation and twitch force at 60 mm Hg tourniquet compression and above were significantly lower ( P<0.05) than baseline value. Reduced twitch force was correlated in a dose-dependent manner with reduced muscle oxygenation ( r=0.78, P<0.001). Although the correlation does not prove causation, the results indicate that ischemia leading to a 7% or greater reduction in muscle oxygenation causes decreased muscle force production in the forearm extensor muscle. Thus, ischemia associated with a modest decline in TO 2 causes muscle fatigue.

Accidental Injuries by HIV-Contaminated Instruments in Health Provider or Research Environments: Can Seroconversion be Prevented?

The rate of seroconversion from percutaneous needlestick exposure to HIV infection is approximately 0.3 per cent. To investigate the possibility of local confinement of HIV, 100 to 200 nm Tc-99m sulfur colloid particles were injected in the canine model subcutaneously at the knee level and collected proximally at the groin from the cannulated femoral vein and lymphatic channel. Tourniquet compression (250 mm Hg) was used as an intervention to possibly restrict particle spread. It was found that particles arrived in the blood at 2.81 +/- 0.54 minutes, with later arrival in the lymph at 6.0 +/- 1.47 minutes. Tourniquet application delayed the appearance of the particulate matter in the blood up to 7.11 +/- 1.5 minutes and in lymph up to 40.0 +/- 5.10 minutes. The concentration of radioactivity in the lymph was higher than in the venous blood. The distribution of the particles reflected by flux was comparable in both pathways. The accumulation curves did not reach plateaus during 45 minutes in lymph and 15 minutes in blood. Radioactive scanning revealed that about 90 per cent of the injected particles remained locally with gradual release for at least 45 minutes. Our results suggest that HIV, introduced by needlestick injury, can be contained for possible viricidal treatment if the response includes rapid immobilization and tourniquet of the area.

TISSUE HYPOXIA CAUSES MUSCLE FORCE REDUCTION

209 Muscle fatigue is a common musculoskeletal disorder in the workplace where low levels of sustained static muscle contraction may limit blood flow to muscle tissue. Although many factors such as increased lactate or decreased PCr levels have been implicated in muscle force reduction, hypoxia may be a primary factor. We hypothesized that hypoxia causes reduced muscle force production in the extensor carpi radialis (ECR) muscle of the forearm. We used near infrared spectroscopy to measure muscle oxygenation (TO2) levels and electrical stimulation (1 Hz, 0.1 ms) to elicit muscle twitch force in 9 healthy subjects. Subjects contracted their forearm for 1 min at 5, 10, 15, and 50% MVC levels. Separately, we applied a tourniquet cuff proximal to the ECR muscle to decrease blood flow and oxygen delivery to the ECR muscle. Mean TO2 decreased from resting baseline (100% TO2) to 89±4% (SE), 81±8%, 78±8%, and 47±8% at 5, 10, 15, and 50% MVC, respectively. TO2 levels at 10, 15, and 50% MVC were significantly lower (p<=0.05) than baseline values. During tourniquet compression, mean TO2 decreased from baseline (100% TO2) to 99±1.2% (SE), 96±1.9%, 93±2.8%, 90±2.5%, and 86±2.7% at 20, 40, 60, 69, and 106 mmHg cuff pressures, respectively. Mean force decreased from control (cuff at 0 mmHg) to 99±0.7% (SE), 96±2.7%, 93±3.1%, 88±3.2%, and 86±2.6% at 20, 40, 60, 69, and 106 mmHg cuff pressures, respectively. Reduced twitch force was strongly associated with reduced TO2 (r2=0.99). These results indicate not only that TO2 decreases significantly at low levels of static muscle contraction, but that force production decreases with only a 7% reduction in TO2.

Effects of tourniquet compression on neuromuscular function.

Neuromuscular function in New Zealand White rabbits was evaluated after thigh tourniquet compression in the directly compressed quadriceps muscles and the distal tibialis anterior by measuring isometric contractile function after supramaximal stimulation of the motor nerve. Tourniquet compression resulted in markedly decreased force production beneath and distal to the tourniquet. Two days after compression, maximal quadriceps force production was decreased to 46% of control values with 125 mm Hg compression and 21% of control values after 350 mm Hg compression. Maximum tibialis anterior force production declined to 70% of control values after 125 mm Hg thigh compression and 24% of control values after 350 mm Hg thigh compression. Functional deficits were greater in the directly compressed quadriceps muscles, but the quadriceps and tibialis anterior had significantly increased impairment when the tourniquet inflation pressure was increased from 125 mm Hg to 350 mm Hg. Three weeks after compression, quadriceps function had returned to 94% of control value after 125 mm Hg compression and 83% after 350 mm Hg. Tibialis anterior function returned to 88% of control values after 125 mm Hg thigh compression and 83% after 350 mm Hg. Clinically, the use of lower inflation pressures may minimize the complications of tourniquet use and enhance postoperative recovery.

Intermittent reperfusion fails to prevent posttourniquet neurapraxia.

This study examined the effects of intermittent reperfusion on peripheral nerve function. Rabbits were randomized to undergo 4 hours of 350 mm Hg tourniquet compression to a hind limb either continuously, interrupted by a single 10-minute reperfusion interval after 2 hours, or interrupted by 10 minutes of reperfusion after each hour. A control group had the tourniquet applied for 4 hours but it was never inflated. The animals were examined clinically for neuromuscular dysfunction and the structure and function of the peripheral nerves were evaluated 1 week after tourniquet compression. Animals that underwent compression had a foot drop and decreased toe-spread reflex. There was greater intraneural edema and slower nerve conduction velocity in nerve segments that were directly compressed by the tourniquet but no apparent abnormalities in segments distal to the tourniquet. Intermittent reperfusion failed to diminish the clinical, structural, or functional consequence of the neurologic injury.

Pathology study of rabbit calf muscles after repeated compression

: To elucidate the pathogenesis of chronic compartment syndrome, we examined pathological changes in the soleus (red) and extensor digitorum longus (EDL; white) muscles in Japanese white rabbits after repeated compression with a pneumatic tourniquet. Repeated tourniquet compression via cuff inflation was carried out on the rabbits, calves daily, for 2h, then stopped for 30min, and then applied for another 2h. The contralateral hindlimb, which was not compressed, served as a control. Animals were allocated to 15 groups, with pressures of 40, 80, and 120mmHg for periods of 1 day, 3 days, 1 week, 2 weeks, and 4 weeks. Skeletal muscle specimens in each group were studied by histopathological and histochemical (ATPase) methods. After compression for 1 day, regardless of pressure, and compression for 3 days in the 40-mmHg pressure group, edematous changes in regions with mild inflammation and increases in fiber diameter were observed in the muscles. After compression for 3 days in the 80- and 120-mmHg pressure groups, and after 1, 2, or 4 weeks in the 40-mmHg pressure group, a few necrotic fibers and scattered fibers with some mononuclear cell infiltrates indicative of early-stage necrosis were detected. In the groups with 80 or 120mmHg pressure for 1, 2, or 4 weeks, muscle fibers exhibited marked degenerative changes, which were more pronounced in the 120-mmHg group than in the 80-mmHg group. The pathological changes were more pronounced in the soleus than in the EDL muscles, indicating that these two muscles differed in sensitivity to repeated compression. Additionally, average muscle wet weight and average fiber diameter for both types of muscle were increased in the 1-day and 3-day compression groups and decreased in the 1-week, 2- week, and 4-week compression groups. These findings clearly differ from those of previously reported single-compression experiments. Our findings indicate that repeated compression may cause serious muscle degeneration, particularly in red muscles.