Skin protection beneath the tourniquet a prospective randomized trial

Background: Complications have been reported as a consequence of tourniquet application. These include skin abrasions, blisters and, breaks. The purpose of the present study was to evaluate the difference in clinical outcome using tourniquets with and without skin protection. Methods: A prospective randomized trial was performed on consecutive patients undergoing elective total knee replacement or knee arthroscopy. The patients were randomly allocated to one of three treatment groups: group 1, tourniquet without skin protection; group 2, tourniquet with Soffban skin protection (BSN Medical, Melbourne, Australia); and group 3, tourniquet with the Atlantech skin protection drape (Atlantech Medical Devices, Harrogate, UK). All patients had identical tourniquets, tourniquet pressure and skin sterilization method. At the conclusion of the case, the tourniquet was removed and the skin beneath the tourniquet was inspected and recorded into one of four categories: skin normal, skin abrasions, skin blisters and skin break. Results: One hundred and fifty consecutive eligible patients having a total knee replacement or arthroscopy were included in the present study. There were 82 total knee replacements and 68 knee arthroscopies There were 89 women and 61 men, the mean age was 51 years. No significant difference in patient demographics were found between the groups. The overall skin complication rate was lower in the tourniquet skin protected groups. Total skin complication rate in the non-skin tourniquet protected group was 12 patients out of 50. In the skin protected tourniquet groups, the number of skin complications was six out of 100. This was statistically significant P = 0.0034 (chi(2)-test). Conclusion: We recommend that lower limb tourniquets should be used with skin protection beneath them.