Use of the tourniquet in reconstructive surgery in patients with previous ipsilateral lower extremity...

Tourniquet use in the previously revascularized ipsilateral lower extremity varies among micro-reconstructive surgeons due to the possible complication of graft failure. Examination of evidence-based literature and a current standard of care is needed to establish guidelines for such tourniquet use. Surveys were sent to vascular surgery program directors of ACGME-accredited residency programs to assess prevailing tourniquet use instruction. The survey addressed issues, including tourniquet use in previous bypass surgery, previous angioplasty, and location relative to graft anatomy. Twenty-eight responses were received out of 87 surveys sent (32 percent response rate). Ninety-three percent considered tourniquet use inappropriate in the ipsilateral lower extremity with previous revascularization. Seventy-one percent indicated tourniquet use inappropriate in previous ipsilateral angioplasty. Sixty-one percent regarded graft conduit type to be important in tourniquet use. There remains a lack of prospective, randomized, controlled studies determining risks of occlusion and other complications to the preexisting bypass graft during tourniquet use. Until such studies are done, this survey recommends avoiding tourniquet use in this patient population.