Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Ankle tourniquet & thalassaemia

Discussion in 'Foot Surgery' started by Dieter Fellner, Jan 27, 2005.

  1. Dieter Fellner

    Dieter Fellner Well-Known Member


    Members do not see these Ads. Sign Up.
    I have a patient with this blood disorder who is asymptomatic and he needs a subungual exostectomy (5th toe) - is it safe to use an ankle tourniquet for foot surgery?
     
  2. Lee

    Lee Active Member

    Hi Dieter,
    I found the following references which may be of interest (despite being a bit old):

    Adu-Gyamfi Y, Sankarankutty M, Marwa S. Use of a tourniquet in patients with sickle-cell disease.Can J Anaesth. 1993 Jan;40(1):24-7

    Fifteen patients, 13 male and two female, known to be carrying the sickle-cell gene (12 HbSS and 3 HbAS), who were undergoing operations requiring a bloodless field, were included in the study. Of the 12 with HbSS, seven had haemoglobin A1 component of between 11 and 27%, three had fetal haemoglobin ranging from 5.7 to 29% and the remaining two had increased haemoglobin A2 concentrations suggesting a beta non-thalassaemia combination. All had a tourniquet applied to the appropriate limb and were given general anaesthesia with moderate hyperventilation throughout the procedure. The tourniquet inflation time was 61.7 +/- 27.5 min. The mean PaO2 remained above 200 mmHg, mean PaCO2 was less than 37 mmHg, and pH ranged between 7.40 and 7.45. There were no clinically important changes in BP or ECG. All patients made uneventful recoveries and none developed sickle-cell crises. It is suggested that it is safe to use tourniquet in patients with sickle-cell disease provided optimum acid-base status and oxygenation are maintained throughout the procedure.


    Stein RE, Urbaniak J. Use of the tourniquet during surgery in patients with sickle cell hemoglobinopathies. Clin Orthop. 1980 Sep;(151):231-3.

    Twenty-one patients carrying the sickle cell gene underwent 29 operative procedures using tourniquet-induced ischemia. No statistically increased incidence of complications occurred in the sickle cell group when compared with a control group of black patients who did not have the sickle cell trait, but who underwent similar operative procedures. There was no obvious contraindication to the use of the tourniquet in patients carrying the sickle cell gene.


    Oginni LM, Rufai MB. How safe is tourniquet use in sickle-cell disease? Afr J Med Med Sci. 1996 Mar;25(1):3-6

    Nineteen patients with sickle-cell haemoglobinopathy (HbSS-14; HbSC-5) aged five years to twenty-three years who had twenty orthopaedic operations performed under tourniquet at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife between June 1987 and May 1991 were studied. The incidence of complications in these patients were compared with a control group of patients with HbAA who had similar operations under tourniquet and were matched for age and sex. There were seven patients with complications in the sickle cell anaemia group and three in the control group. Only three complications in the study group were significant. These were bone pains, severe post-operative pain and jaundice. Another complication was tissue oedema. The incidence of complications was significantly higher in the sickle cell patients than the normal group (P < 0.01). There were no mortalities. All complications resolved within two weeks of non-invasive management.

    And there's an old JAPMA article : Willinsky JS, Lepow R. Sickle cell trait and use of the pneumatic tourniquet. A case report. J Am Podiatry Assoc. 1984 Jan;74(1):38-41

    Good luck with it,
    Lee
     
  3. Ian Reilly

    Ian Reilly Active Member

    Hi Dieter

    Just picked up a thalassaemia patient myself for HAV surgery. A friend of mine who’s’ an anaesthetist saved me the trouble of an internet search and said it would be fine…! He's very good at that sort of thing...

    Ian

    Ps – got the first of those articles for you – let me have your snail mail address…
     
  4. Dieter Fellner

    Dieter Fellner Well-Known Member

    Lee

    Thanks for the references!
     
Loading...

Share This Page