The authors' tip to prevent chemical burns fails to emphasise that alcoholic skin preparation is the greatest risk factor, yet is exchangeable for the much safer aqueous povidone–iodine.1 The chemical burn below the unprotected tourniquet is well documented and is still encountered in our practice as plastic surgeons.2
The Atlantech tourniquet drape (Arthrocare) costs about £3.50 and can protect large thighs and upper limbs providing an adhesive seal to the skin, integrated padding and fold-over protection of the tourniquet from soiling. A pair of surgical gloves costs about £1.15 with a less effective elastic, there is also the possible disadvantage of a venous tourniquet effect when the pneumatic tourniquet is deflated.
We suggest that Bruner's Ten Rules for Safe Tourniquet Use should be updated to include:3,4 (i) using an occluding dressing or drape to prevent fluid spread into the padding or onto the tourniquet; and (ii) a new eleventh rule to avoid alcoholic skin preparations for paediatric and elderly patients and its restricted use on adults.
The patient morbidity and cost to the NHS from adverse tourniquet events will be greatly reduced with adherence to these rules.
Footnotes
COMMENT ON doi 10.1308/003588408X285720 PJ Tomlinson, WJ Harries. The use of a surgical glove in the prevention of tourniquet-associated chemical burns. Ann R Coll Surg Engl 2008; 90: 255
References
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