Abstract
Although limb exsanguination prior to tourniquet inflation is usually accomplished using mechanical devices, elevation alone may still be employed under circumstances where mechanical means are contraindicated. The rather confusing advice within the literature as to duration of elevation, stimulated a study in the arm which revealed the optimal duration of elevation to be 5 min, a period somewhat longer than generally advised. Because the pattern of venous drainage within the leg is slightly different to that of the arm, we undertook a similar study to ascertain if our findings for the arm also held true for the leg. Volume changes in the calves of seven male volunteers during elevation at 45 degrees and 90 degrees were assessed using strain gauge plethysmography. To achieve maximal exsanguination it is recommended that the leg should be elevated at an angle of 45 degrees for 5 min. Higher angles of elevation produce slower and less complete exsanguination.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Binns M., Pho R. Femoral vein occlusion during hip arthroplasty. Clin Orthop Relat Res. 1990 Jun;(255):168–172. [PubMed] [Google Scholar]
- CLARKE R. S., HELLON R. F. Venous collection in forearm and hand measured by the strain-gauge and volume plethysmograph. Clin Sci. 1957 Feb;16(1):103–117. [PubMed] [Google Scholar]
- Colville J., Small J. O. Exsanguination of the upper limb in hand surgery comparison of four methods. J Hand Surg Br. 1986 Oct;11(3):469–470. doi: 10.1016/0266-7681(86)90187-7. [DOI] [PubMed] [Google Scholar]
- DiStefano V., Nixon J. E., Stone R. H. Bioelectrical impedance plethysmography as an investigative tool in orthopaedic surgery. A comparative study of limb exsanguination techniques. Clin Orthop Relat Res. 1974 Mar-Apr;(99):203–206. doi: 10.1097/00003086-197403000-00027. [DOI] [PubMed] [Google Scholar]
- Griffiths J. C., Heywood O. B. Bio-mechanical aspects of the tourniquet. Hand. 1973 Jun;5(2):113–118. doi: 10.1016/0072-968x(73)90050-8. [DOI] [PubMed] [Google Scholar]
- WHITNEY R. J. The measurement of volume changes in human limbs. J Physiol. 1953 Jul;121(1):1–27. doi: 10.1113/jphysiol.1953.sp004926. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Warren P. J., Hardiman P. J., Woolf V. J. Limb exsanguination. I. The arm: effect of angle of elevation and arterial compression. Ann R Coll Surg Engl. 1992 Sep;74(5):320–322. [PMC free article] [PubMed] [Google Scholar]