[Skin lesions following the use of a tourniquet]

In a questionnaire study including 44 AO-clinics in German speaking countries, we investigated frequencies and possible causes of skin lesions under the cuff occurring after surgery in a bloodless field. Though these lesions are hardly dealt with in the literature available, the number of legal claims made by patients for these lesions has significantly increased in recent years. What has to be clearly differentiated are the known changes deeply extending into the soft tissues we see in the tourniquet syndrome. The precise pathogenetic mechanisms of these lesions are unknown. The combination of fluid collecting under the cuff and pressure applied to the skin by the cuff seems to be a likely cause. The most important precautions for avoiding these skin lesions consist in correct application of the cuff and in sealing the edge of the cuff the way that at least distally it will be safely fluid-tight. Correspondingly, fluid must under no circumstances (disinfectants) be allowed to collect or pool between the operating table and resting parts of the body (sacral region!). Based on present knowledge it is not possible to safely avoid these typical skin lesions. Strict adherence to the precautions listed above and explained in more detail in the text should therefore lead to the rejection of legal claims brought in such instances.