Pneumatic tourniquet use in foot and ankle surgery--is padding necessary?

Background: The majority of foot and ankle surgery is carried out in a bloodless field achieved by the use of a pneumatic tourniquet. The risks of tourniquet use may be divided into those resulting from direct mechanical pressure from the cuff and those secondary to prolonged limb ischaemia. Current peri-operative guidelines advise the use of padding beneath the cuff, in particular to reduce skin complication.

Objectives: To assess the complication rate of tourniquet use when the cuff is applied directly to the skin.

Method: Patients undergoing foot and ankle surgery under tourniquet control without use of padding were assessed pre and post operatively for soft tissue complication, neurological deficit and post-tourniquet syndrome.

Results: We recorded findings for 97 patients, 47 thigh and 50 ankle tourniquets. We found a complication rate of 0%. There were no cases of skin blistering, abrasion, bruising, laceration or burn.

Conclusions: These findings are contrary to published RCTs supporting the use of padding. Our study demonstrates the safe use of pneumatic tourniquets without padding in foot and ankle surgery.