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The unforgettable finger tourniquet
Injury, Int. J. Care Injured 33 (2002) 76 – 77 www.elsevier.com/locate/injury
The unforgettable finger tourniquet Sarah Tucker a,*, Peter Christian Harris b a
Department of Plastic Surgery, SHO in Plastic Surgery, Frenchay Hospital, Frenchay, Bristol, UK b SpR in Orthopaedic and Accident Surgery, Mersey Deanery, UK Accepted 12 June 2001
Fig. 1. A Derma Prene™ glove ready for use as a finger tourniquet. The glove used should be approximately the size of the patient’s hand and the corresponding finger is cut off, applied to the finger, and rolled down.
For surgery confined to the finger, a finger tourniquet is often preferred over an arm tourniquet since it avoids unnecessary tissue ischaemia and, for procedures carried out under digital nerve block alone, will be tolerated by the patient for longer. There are commercially produced finger tourniquets [1,2], but these tend to be expensive compared with using simple devices constructed from equipment that is readily available in any operating theatre. A simple and popular method of making a finger tourniquet involves cutting the finger off from a surgical glove approximating to the size of the patient’s
* Corresponding author. Present address: 1 Hillsborough, Main Road, Temple Cloud, Bristol BS39 5BL, UK. Tel.: + 01761-452295. E-mail address: [email protected] (S. Tucker).
hand, cutting a small hole in the tip, and applying it to the patient’s finger. It is then rolled down so that it exsanguinates the finger and becomes a tourniquet at the base [3,4]. There were theoretical concerns raised about excessive pressure under the tourniquet [5], but this has been disproved in experimental studies measuring pressure with transducers [6,7]. These showed that if the glove used is the same size as the patient’s hand the mean pressure generated was 355 mmHg, and uniformly less than 500 mmHg independent of the operator’s experience of the technique. Most surgeons wear and therefore make their tourniquets from gloves that are clear or fleshcoloured. These tourniquets are, in effect, camouflaged. There have been a small number of cases where the tourniquet has been inadvertently left on, resulting in necrosis of the digit [8,9].
0020-1383/02/$ - see front matter © 2002 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 1 ) 0 0 0 9 5 - X
S. Tucker, P.C. Harris / Injury, Int. J. Care Injured 33 (2002) 76–77
77
Fig. 2. A bright green glove used as a finger tourniquet would be difficult to miss at the end of an operation.
We suggest using a coloured glove instead. The majority of latex free gloves are bright green (Fig. 1) e.g. Derma Prene™ (powder free), produced by Ansell Medical. The surgeon who applies a tourniquet should always ensure that the theatre staff document the time of application. This should prompt a reminder to remove the tourniquet at the end of the procedure in order to complete the documentation. However, the use of a more clearly visible glove for the finger tourniquet (Fig. 2) would make it extremely unlikely to be left on, even if these measures fail.
Acknowledgements Department of Medical Illustration, Frenchay Hospital.
References [1] McEwen JA, Gropper PT, McGraw RW. New Finger cuffs for use with digital tourniquets. J Hand Surg [Am] 1988;13(6):888 – 92. [2] Tountas CP. A disposable pneumatic digital tourniquet. J Hand Surg [Am] 1986;11(4):600 – 1. [3] Shah A, Asivatham R, Ellis D. Tips of the trade: 42. An improved technique for creating a digital tourniquet. Orthop Rev 1992;21(1):91 – 2. [4] Salem MZ. Simple finger tourniquet, Br. Med. J. 2(869):779. [5] Lubahn JD, Koeneman J, Kosar K. The digital tourniquet: how safe is it? J Hand Surg [Am] 1985;10(5):664 – 9. [6] Hixson FP, Shafiroff BB, Werner FW, Palmer AK. Digital tourniquets: a pressure study with clinical relevance. J Hand Surg [Am] 1986;11(6):865 – 8. [7] Shaw JA, DeMuth WW, Gillespy AW. Guidelines for the use of digital tourniquets based on physiological pressure measurements. J Bone Joint Surg [Am] 1985;67(7):1086 – 90. [8] Hoare EM. Simple finger tourniquet. Br Med J 1973;3(864):293. [9] Sheng-Mou H, Tang-Kue L. Salvage of tourniquet-induced thumb necrosis by a modified wraparound procedure. J Trauma Inj Infect Crit Care 1987;27(7):803 – 5.
The unforgettable finger tourniquet Sarah Tucker a,*, Peter Christian Harris b a
Department of Plastic Surgery, SHO in Plastic Surgery, Frenchay Hospital, Frenchay, Bristol, UK b SpR in Orthopaedic and Accident Surgery, Mersey Deanery, UK Accepted 12 June 2001
Fig. 1. A Derma Prene™ glove ready for use as a finger tourniquet. The glove used should be approximately the size of the patient’s hand and the corresponding finger is cut off, applied to the finger, and rolled down.
For surgery confined to the finger, a finger tourniquet is often preferred over an arm tourniquet since it avoids unnecessary tissue ischaemia and, for procedures carried out under digital nerve block alone, will be tolerated by the patient for longer. There are commercially produced finger tourniquets [1,2], but these tend to be expensive compared with using simple devices constructed from equipment that is readily available in any operating theatre. A simple and popular method of making a finger tourniquet involves cutting the finger off from a surgical glove approximating to the size of the patient’s
* Corresponding author. Present address: 1 Hillsborough, Main Road, Temple Cloud, Bristol BS39 5BL, UK. Tel.: + 01761-452295. E-mail address: [email protected] (S. Tucker).
hand, cutting a small hole in the tip, and applying it to the patient’s finger. It is then rolled down so that it exsanguinates the finger and becomes a tourniquet at the base [3,4]. There were theoretical concerns raised about excessive pressure under the tourniquet [5], but this has been disproved in experimental studies measuring pressure with transducers [6,7]. These showed that if the glove used is the same size as the patient’s hand the mean pressure generated was 355 mmHg, and uniformly less than 500 mmHg independent of the operator’s experience of the technique. Most surgeons wear and therefore make their tourniquets from gloves that are clear or fleshcoloured. These tourniquets are, in effect, camouflaged. There have been a small number of cases where the tourniquet has been inadvertently left on, resulting in necrosis of the digit [8,9].
0020-1383/02/$ - see front matter © 2002 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 1 ) 0 0 0 9 5 - X
S. Tucker, P.C. Harris / Injury, Int. J. Care Injured 33 (2002) 76–77
77
Fig. 2. A bright green glove used as a finger tourniquet would be difficult to miss at the end of an operation.
We suggest using a coloured glove instead. The majority of latex free gloves are bright green (Fig. 1) e.g. Derma Prene™ (powder free), produced by Ansell Medical. The surgeon who applies a tourniquet should always ensure that the theatre staff document the time of application. This should prompt a reminder to remove the tourniquet at the end of the procedure in order to complete the documentation. However, the use of a more clearly visible glove for the finger tourniquet (Fig. 2) would make it extremely unlikely to be left on, even if these measures fail.
Acknowledgements Department of Medical Illustration, Frenchay Hospital.
References [1] McEwen JA, Gropper PT, McGraw RW. New Finger cuffs for use with digital tourniquets. J Hand Surg [Am] 1988;13(6):888 – 92. [2] Tountas CP. A disposable pneumatic digital tourniquet. J Hand Surg [Am] 1986;11(4):600 – 1. [3] Shah A, Asivatham R, Ellis D. Tips of the trade: 42. An improved technique for creating a digital tourniquet. Orthop Rev 1992;21(1):91 – 2. [4] Salem MZ. Simple finger tourniquet, Br. Med. J. 2(869):779. [5] Lubahn JD, Koeneman J, Kosar K. The digital tourniquet: how safe is it? J Hand Surg [Am] 1985;10(5):664 – 9. [6] Hixson FP, Shafiroff BB, Werner FW, Palmer AK. Digital tourniquets: a pressure study with clinical relevance. J Hand Surg [Am] 1986;11(6):865 – 8. [7] Shaw JA, DeMuth WW, Gillespy AW. Guidelines for the use of digital tourniquets based on physiological pressure measurements. J Bone Joint Surg [Am] 1985;67(7):1086 – 90. [8] Hoare EM. Simple finger tourniquet. Br Med J 1973;3(864):293. [9] Sheng-Mou H, Tang-Kue L. Salvage of tourniquet-induced thumb necrosis by a modified wraparound procedure. J Trauma Inj Infect Crit Care 1987;27(7):803 – 5.