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Tourniquet use is not associated with limb loss following military lower extremity arterial trauma

Kauvar, David S., MD; Miller, Diane, MSN, MPH; Walters, Thomas J., PhD

Journal of Trauma and Acute Care Surgery: September 2018 - Volume 85 - Issue 3 - p 495–499
doi: 10.1097/TA.0000000000002016

BACKGROUND The effect of battlefield extremity tourniquet (TK) use on limb salvage and long-term complications following vascular repair is unknown. This study explores the influence of TK use on limb outcomes in military lower extremity arterial injury.

METHODS The study database includes cases of lower extremity vascular injury from 2004 to 2012 with data recorded until discharge from military service. We analyzed all limbs with at least one named arterial injury from the femoral to the tibial level. Tourniquet (TK) and no TK (NTK) groups were identified. Univariate analyses were performed with significance set at p ≤ 0.05.

RESULTS A total of 455 cases were included, with 254 (56%) having a TK for a median of 60 minutes (8–270 minutes). Explosive injuries (53%) and gunshot wounds (26%) predominated. No difference between TK and NTK was present in presence of fracture, level of arterial injury, type of arterial repair, or concomitant venous injury. More nerve injuries were present in the TK group, and Abbreviated Injury Scale extremity and Mangled Extremity Severity Score tended toward greater injury severity. Amputation and mortality rates did not differ between groups, but the incidence of severe edema, wound infection, and foot drop was higher in the TK group. Vascular above-knee amputation, arterial repair complication, and severe edema were higher in the TK group also (p = 0.10). Tourniquet duration of 60 minutes or longer was not associated with increased amputations, but more rhabdomyolysis was present.

CONCLUSION Field TK use is associated with wound infection and neurologic compromise but not limb loss. This may be due to a more severe injury profile among TK limbs. Increased TK times may predispose to systemic, but not limb, complications.

LEVEL OF EVIDENCE Therapeutic/care management, level IV.

From the Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas (D.S.K.); Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland (D.S.K.); and Department of Tactical Combat Casualty Care Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas (D.M., T.J.W.).

Submitted: May 16, 2018, Revised: June 14, 2018, Accepted: June 18, 2018, Published online: July 17, 2018.

Address for reprints: Thomas J Walters, PhD, United States Army Institute of Surgical Research, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234; email:

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© 2018 Lippincott Williams & Wilkins, Inc.