Advances in surgical tourniquets

James A McEwen G F Auchinleck E very year in North America, an estimated 10,000 surgical tourniquets are used in approximately one million procedures. Despite the almost universal use of such tourniquets for surgery of the extremities, recent studies show every use results in some injury to the patient. The nature, extent, and duration of such injuries are largely a result of characteristics of the tourniquets used.1 Increased awareness of tourniquet-related injuries and hazards may lead to the development of new standards for surgical tourniquets.2 The history of nonpneumatic and pneumatic tourniquets in surgery has been reviewed extensively.3 it is recorded that Roman surgeons used constricting devices for amputation. In 1718, the French surgeon Jean Louis Petit developed a screw device for hemostasis. Because of its turning action, Petit called the device a tourniquet. Tourniquets were fIrst used in surgical procedures other tban amputations in 1864. Figure 1 shows a nineteenth century tourniquet from an amputating and general surgery set. Since that time, three technical advances have facilitated the development of bloodless-field· surgery: . • the introduction by Esmarch of an elastic-wrap bandage for exsanguination of a limb before tourniquet application • the introduction of a pneumatic tourniquet by Cushing in 1904 • the development of an automated, microprocessor-based tourniquet in 1982. The use of tourniquets in surgery has been acompanied by reports of limb