Clinical safety and efficacy of calf tourniquets

A clinical study was undertaken to ascertain the utility and complication rate of proximal calf tourniquet use for foot and ankle surgery. The surgical and clinical records of 446 patients undergoing foot and ankle surgery between March 1992 and December 1994 were examined for details pertaining to intraoperative tourniquet use and postoperative evidence of neurologic or vascular complications. All patients who had surgery performed under tourniquet control were included in the study. A total of 454 limbs were operated on: 8 patients underwent bilateral surgical procedures. The patients comprised 172 men and 274 women. The average age was 48.9 (±16.0 SD) years. Surgery was completed in one tourniquet period in 435 cases (95.8%) and in two periods of tourniquet inflation in 19 cases (4.2%). The average duration of tourniquet ischemia was 49.2 minutes (±30.7 SD) for one tourniquet period and 131.1 minutes (±46.0 SD) for two tourniquet periods. No postoperative compromise to either neurologic or vascular function was detected. Specifically, no alteration in peroneal nerve function was seen. We conclude that a calf tourniquet placed proximally with adequate cast padding is a safe and effective method to achieve a bloodless surgical field for foot and ankle surgery.