Intraoperative pneumatic tourniquet application reduces soft-tissue microcirculation, but without affecting wound healing in calcaneal fractures

European journal of medical research, vol. 29, pp. 462

Abstract

Abstract Background Wound healing complications are a major challenge following the extended lateral approach in calcaneal fractures. Soft-tissue microcirculation plays an important role via the delivery of oxygen, nutrients, and the regulation of a local milieu. The aim of this clinical study was to examine the effect of intraoperative pneumatic tourniquet application on skin and subcutaneous microcirculation, and its impact on wound healing progression. Methods Patients with calcaneal fractures were randomly assigned to two groups defined by a surgery conducted either with use or without use of a tourniquet. Blood flow (BF [AU]), tissue oxygen saturation (SO 2 [%]) and the relative amount of haemoglobin (rHb[AU]) were intraoperatively measured at two depths (2 and 8 mm) non-invasively by spectrophotometry (Micro-Lightguide O2C ® , LEA Medizintechnik, Giessen, Germany). Time points were before and after inflation of the pneumatic tourniquet and also at the end of surgery before deflation. A linear mixed model (LMM) was fitted for statistical analysis. Results Thirty-four patients (3 women and 31 men) with 37 calcaneal fractures were included. In 22 of them, the surgery was conducted with a tourniquet and in the other 15 without its use. A significant decrease of microcirculation, characterized by decreases in blood flow (p = 0.011) and tissue oxygenation (p = 0.023) was measured in 8 mm depth after inflating the tourniquet. However, these changes did not influence the time of postoperative wound healing. Conclusion The use of a pneumatic tourniquet reduces deep microcirculation without affecting postoperative wound healing. Trial registration The study was registered in www.ClinicalTrials.gov (NCT01264146).

Authors 13

1. Philipp Lichte corresponding Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany. plichte@ukaachen.de

2. Felix Bläsius Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany

3. Bergita Ganse

   Saarland University

   Affiliation as printed

   Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany

   Werner Siemens Foundation Endowed Chair of Innovative Implant Development, Saarland University, Homburg, Germany

4. Boyko Guergov Gueorguiev
   Affiliation as printed

   AO Research Institute Davos, 7270, Davos, Switzerland

5. Torsten Pastor

   Luzerner Kantonsspital

   Affiliation as printed

   Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6000, Lucerne, Switzerland

6. Sven Nebelung Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074, Aachen, Germany

7. Filippo Migliorini Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany

8. Kajetan Klos

   Jena University Hospital · Friedrich Schiller University Jena

   Affiliation as printed

   Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany

   Gelenkzentrum Rhein-Main, Hochheim, Germany

9. Ali Modabber Aachen Department of Oral and Maxillofacial Surgery

   Universitätsklinikum Aachen

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany

10. Mario F. Scaglioni

    Luzerner Kantonsspital

    Affiliation as printed

    Department of Hand- and Plastic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland

11. Clemens O. Schopper

    Johannes Kepler University of Linz · Kepler Universitätsklinikum

    Affiliation as printed

    Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria

12. Frank Hildebrand Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany

13. Matthias Knobe corresponding Aachen Medical Faculty

    University of Zurich · Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Orthopaedic Trauma, Westmuensterland Hospital, 48683, Ahaus, Germany. Matthias.knobe@uzh.ch

    Medical Faculty, RWTH Aachen University Hospital, 52074, Aachen, Germany. Matthias.knobe@uzh.ch

    Medical Faculty, University of Zurich, 8091, Zurich, Switzerland. Matthias.knobe@uzh.ch