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Microvascular surgery in a bloodless field
Author(s) -
Dumanian Gregory A.,
Chen Alexandria
Publication year - 2000
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/1098-2752(2000)20:5<221::aid-micr2>3.0.co;2-z
Subject(s) - medicine , tourniquet , microsurgery , microvascular surgery , surgery , tissue plasminogen activator , hemostasis , anesthesia , thrombelastography , coagulation , microcirculation
Abstract Although tourniquets play an integral role in extremity surgery, no clear guidelines exist for the use of tourniquets in microsurgery. We undertook a study in 12 healthy volunteers to better understand the coagulation properties of blood distal to an inflated tourniquet. At a 15‐min inflation time, blood distal to an inflated tourniquet clots faster than blood taken from the opposite arm after addition of exogenous thrombin (12.5 s vs 17.5 s, P < 0.0001). Neither fibrinopeptide A (FPA) levels nor tissue plasminogen activator (tPA) levels were different from those of controls. Tissue factor pathway inhibitor (TFPI), an endogenous local anticoagulant, was slightly but significantly elevated in tourniquet blood. Although much remains to be understood, we believe that microvascular surgery in a bloodless field is safe and efficacious. Nine patients are presented who successfully underwent microvascular surgery in a bloodless field, using various types of extremity tourniquets. © 2000 Wiley‐Liss, Inc. MICROSURGERY 20:221–224 2000