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A biomechanical analysis of limb compression induced by pneumatic surgical tourniquets Callaghan, Stephen Francis Paul


The introduction of the pneumatic tourniquet has greatly facilitated orthopedic limb surgery. However, the use of this occlusive device is still associated with recurring cutaneous, vascular and neuromuscular injuries. The present research investigates the transmission of pressure from the pneumatic tourniquet to the underlying limb in order to isolate and perhaps minimize the destructive forces causing post-surgical injuries. A finite element analysis of the tourniquet/limb combination is performed for several patient and cuff parameters. In particular, the influence of cuff design features (such as cuff width and applied surface pressure profile) and patient features (such as arm radius and fat content) on the levels of destructive forces is assessed. Additionally, the use of an Esmarch bandage together with a pneumatic tourniquet is investigated and compared to the conventional tourniquet configuration. Results from this numerical investigation suggest that high levels of shear and negative axial strain at the cuff edges may account for experimentally observed nerve damage. Furthermore, using wider cuffs which exhibit smooth surface pressure profiles may reduce the risk of post-operative tourniquet-induced nerve injuries. Larger limb radii and greater fat contents generate higher destructive strain levels. And finally, wrapping an Esmarch bandage around the limb at the cuff edges significantly reduces the levels of shear and negative axial strains experienced under occlusion conditions.

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