Use of pneumatic tourniquet in Transtibial amputation for peripheral vascular disease: A prospective randomized blinded controlled trail

Introduction: The traditional view is that tourniquets are contraindicated during amputation surgery with peripheral vascular disease because they might cause damage to arteries in the thigh that are already diseased. Seeing encouraging results from studies done by some researchers we hypothesized that use of a pneumatic tourniquet might improve the outcome following transtibial amputation, without compromising wound healing in a population of elderly patients with peripheral vascular disease. Materials and methods: Fifty patients were chosen for this study who had non-reconstructible peripheral vascular disease and they were randomised to either tourniquet or no tourniquet (control). Blood loss, fall in haemoglobin, transfusion requirements, wound healing, breakdown and revision were recorded. Results: The mean intra-operative blood loss was 5oo ml (range 300–750) in the control group and the median blood loss was 500ml. The mean blood loss was 252 ml (range 150- 500) in the tourniquet group and the median blood loss was 200 ml (p <0.0001). Mean preoperative haemoglobin was 9.09 gm/dL in the tourniquet group versus 9.15 gm/dL in the non tourniquet control group. The mean postoperative haemoglobin fall was 0.63 gm/dl (6.9%) in the tourniquet group and 1.08 gm/dl (11.08%) in the non- tourniquet group (p =0.0001). The mean postoperative hemoglobin in control group was 7.76 gm/dl and in tourniquet was 8.46 gm/dl .One patient (4%) was transfused with one unit of blood in the tourniquet group. In the non-tourniquet group (control group), however, 10 patients (40%) needed a blood transfusion (p=0.03).Two patients (8%) in tourniquet group had wound breakdown which was managed by debridement and secondary closure. Four patients (16%) in control group had wound breakdown. Three pateints (12%) in tourniquet group required revision amputation compared with 5 patients (20%) in control group. Conclusion: Our results show that the use of an tourniquet during below knee transtibial amputation in ischemic limbs significantly reduces intra-operative blood loss, reduces fall in post operative hemoglobin and reduces the need for transfusion without major complications.