Evidence of safety: matching limb protection sleeves with tourniquet cuffs

Posted on March 4, 2013. Filed under: Matching Limb Protection Sleeves, Tourniquet Safety | Tags: , , , , , |

What evidence exists to show the extent to which the use of limb protection sleeves underlying tourniquet cuffs improves patient safety?  It is known that high pressures, high pressure gradients and shear forces applied to skin and soft tissues underlying a tourniquet cuff can cause injuries to the skin and soft tissues including petechiae, blistering, bruising, and pinching.  To reduce the nature and extent of such injuries, studies have been published to determine the relative effectiveness of underlying padding, underlying stockinette, and underlying limb protection sleeves that are matched to specific limb sizes and cuff sizes.

Olivecrona et al. [1] compared the use of elastic stockinette, cast padding, and no protective material underneath a pneumatic tourniquet in 92 patients who underwent a primary total knee arthroplasty and confirmed that an elastic stockinette provided the most effective skin protection during tourniquet use, of the three that were studied.  McEwen et al. [2] compared five different tourniquet cuff sleeve and padding configurations in healthy adult volunteers, and Tredwell et al. [3] tested four different tourniquet cuff sleeve and padding configurations on healthy child volunteers.  Both studies found that stretched sleeves made of two-layer tubular elastic material and matched to specific tourniquet cuff sizes, and thus to limb sizes, produced significantly fewer, less severe pinches and wrinkles in the skin surface than other types of underlying limb protection that were tested, including cast padding, single-layer stockinette, and stockinette not matched to the cuff and limb size.

These studies present evidence that limb protection sleeves improve safety by protecting the skin underlying tourniquet cuffs during tourniquet use, and further provide evidence that greatest safety is achieved through the use of matching limb protection sleeves consisting of two-layer tubular stockinette specifically matched to the limb size and cuff size.  Detailed information about matching limb protection sleeve products is available elsewhere [4].


[1]      J. A. McEwen and K. Inkpen, “Tourniquet Safety: Preventing Skin Injuries,” The Surgical Technologist, no. August 2002, pp. 7–15, 2002.

[2]      S. J. Tredwell, M. Wilmink, K. Inkpen, and J. a McEwen, “Pediatric tourniquets: analysis of cuff and limb interface, current practice, and guidelines for use.,” Journal of Pediatric Orthopedics, vol. 21, no. 5, pp. 671–6, 2001.

[1]      C. Olivecrona, J. Tidermark, P. Hamberg, S. Ponzer, and C. Cederfjäll, “Skin protection underneath the pneumatic tourniquet during total knee arthroplasty: a randomized controlled trial of 92 patients.,” Acta Orthopaedica, vol. 77, no. 3, pp. 519–23, Jun. 2006.

[4]        http://www.delfimedical.com/pts-ii/limb-sleeves

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