The Safety and Effectiveness of an In-Depth Esmarch Tourniquet Technique in Achieving Target Pressures for Pediatric Upper Extremity Surgery

Authors

  • Kanchai Malungpaishrope, MD Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin General Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
  • Prapasiri Charoensri, MD Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin General Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
  • Piyabuth Kittithamvongs, MD Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin General Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
  • Navapong Anantavorasakul, MD Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin General Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
  • Chairoj Uerpairojkit, MD Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin General Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
  • Somsak Leechavengvongs, MD Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin General Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand

DOI:

https://doi.org/10.56929/jseaortho-2023-0188

Keywords:

Esmarch, pressure, tourniquet, upper extremity surgery, children

Abstract

Purpose: This study aimed to determine the appropriate number of turns required for an Esmarch tourniquet, using commonly sized Esmarch bandages, to achieve a pressure target of at least 150 mm Hg during pediatric upper extremity surgery.

Methods: Twenty participants who underwent upper extremity surgery were included in the study. Two surgeons used 2- and 3-inch-sized Esmarch bandages to apply an Esmarch tourniquet to each participant’s arm. The pressure and number of turns were recorded from the second to fifth turns. The pressure was measured using a pressure sensor device.

Results: At the third turn of both the 2- and 3-inch-sized Esmarch bandages, a 150 mm Hg pressure was achieved in all participants. Intra-observer reliability resulted was “good”; however, inter-observer revealed “poor” reliability.

Conclusions: The Esmarch tourniquet is an effective and safe method for creating a bloodless operative field for upper extremity surgery in pediatric patients. The results of this present study suggested the application of three turns of the 2- and 3-inch-sized Esmarch bandages.

Metrics

Metrics Loading ...

References

Eidelman M, Katzman A, Bialik V. A novel elastic exsanguination tourniquet as an alternative to the pneumatic cuff in pediatric orthopedic limb surgery. J Pediatr Orthop B 2006;15:379-84. DOI: https://doi.org/10.1097/01202412-200609000-00014

Green DP. General Pronciples. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green's Operative Hand surgery. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2011. p.3-24.

Charlton NP, Goolsby CA, Zideman DA, et al. Appropriate tourniquet types in the pediatric population: A systematic review. Cureus 2021;13:e14474. DOI: https://doi.org/10.7759/cureus.14474

Tredwell SJ, Wilmink M, Inkpen K, et al. Pediatric tourniquets: analysis of cuff and limb interface, current practice, and guidelines for use. J Pediatr Orthop 2001;21:671-6. DOI: https://doi.org/10.1097/01241398-200109000-00023

Reid HS, Camp RA, Jacob WH. Tourniquet hemostasis. A clinical study. Clin Orthop Relat Res 1983;(177):230-4. DOI: https://doi.org/10.1097/00003086-198307000-00035

Lieberman JR, Staheli LT, Dales MC. Tourniquet pressures on pediatric patients: a clinical study. Orthopedics 1997;20:1143-7. DOI: https://doi.org/10.3928/0147-7447-19971201-08

Biehl WC, Morgan JM, Wagner FW, et al. The safety of the Esmarch tourniquet. Foot Ankle 199;14:278-83. DOI: https://doi.org/10.1177/107110079301400508

Abraham E, Amirouche FM. Pressure controlled Esmarch bandage used as a tourniquet. Foot Ankle Int 2000;21:686-9. DOI: https://doi.org/10.1177/107110070002100811

Downloads

Published

2023-08-01

How to Cite

1.
Malungpaishrope K, Charoensri P, Kittithamvongs P, Anantavorasakul N, Uerpairojkit C, Leechavengvongs S. The Safety and Effectiveness of an In-Depth Esmarch Tourniquet Technique in Achieving Target Pressures for Pediatric Upper Extremity Surgery. JseaOrtho [Internet]. 2023 Aug. 1 [cited 2024 Jul. 27];48(1):3-7. Available from: https://jseaortho.org/index.php/jsao/article/view/188

Issue

Vol. 48 No. 1 (2024): January - June

Section

Original Articles

License

Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Most read articles by the same author(s)