The Esmarch Bandage in Hand Surgery: Historical Overview, Clinical Utility, and Associated Risks

There is no debating the impact of tourniquets on the field of hand surgery. Tourniquets provide considerable utility for surgeons, allowing improved tissue visualization and reduced intraoperative blood loss. Although there are a number of limb exsanguination techniques, the most common is the use of a thin, wide elastic bandage, commonly referred to as the "Esmarch bandage." Described in 1873, the original "Esmarch bandage" exsanguinated the operative limb with a woven rubber bandage before application of a hollow rubber tube on the proximal limb to provide a bloodless surgical field. Johann Friedrich August von Esmarch's contribution was primarily the manner in which he maintained limb ischemia as the bandage used for exsanguination had been previously developed by others. von Esmarch's impact has nevertheless been memorialized by the use of thin, elastic bandage, despite the fact that the current "Esmarch bandage" bears little resemblance to his 19th century rubber tube. In this manuscript, we summarize the history, utility, complications, and current recommendations associated with the modern Esmarch bandage within the context of hand surgery.