Prospective Analysis of Simulated Pneumatic Tourniquet Use and Oedema Following Axillary Lymph Node Dissection

Area of Science:

• Orthopedic Surgery
• Lymphedema Research
• Surgical Safety

Background:

• Controversy exists regarding tourniquet use in patients with a history of axillary lymph node dissection (ALND) due to potential lymphoedema risks.
• Previous studies have not definitively proven or disproven the risk of lymphoedema following tourniquet application in this patient population.

Purpose of the Study:

• To prospectively evaluate upper extremity swelling in patients with a history of unilateral ALND following tourniquet application.
• To assess the safety and reversibility of swelling associated with tourniquet use in this specific patient group.

Main Methods:

• A standardized tourniquet model was employed, applying the tourniquet bilaterally to the upper arms.
• The unaffected arm served as an internal control for comparison.
• Hand volume was measured using an aqueous volumeter before and after tourniquet application and elevation.

Main Results:

• Slightly greater, temporary increases in arm volume were observed in the ALND-affected arms compared to control arms post-tourniquet.
• The observed edema was reversible, with spontaneous resolution of swelling in both arms.
• No significant difference in residual hand volume was found between the ALND and control arms at the study's conclusion.

Conclusions:

• Tourniquet application appears to be safe for patients with a history of ALND.
• The temporary swelling observed is reversible and does not lead to persistent lymphedema in this model.
• Further research in a clinical surgical setting is recommended to confirm these findings.