Surena Namdari, Samir Mehta.
Response/Recommendation: There does not appear to be a high rate of venous thromboembolism (VTE) after the use of tourniquets for upper extremity surgery.
Strength of Recommendation: Limited.
Rationale: Arterial tourniquets are commonly used to achieve a bloodless operative field. While there is some data to suggest an increase in the rates of VTE in lower extremity surgery, this type of data does not exist in the upper extremity. The body of literature on tourniquet use in the upper extremity focuses on an assessment of pain, and post-operative complications, such as hematoma and limb ischemia. Most data are from level IV case series or level III comparative studies1. No study demonstrates an increase in symptomatic VTE with the use of tourniquet in the upper extremity; however, no study also specifically evaluated the possible association between VTE and the use of upper extremity tourniquet. There is one randomized controlled trial comparing minor hand procedures performed with or without the use of a tourniquet2–4. Similarly, the authors did not specifically evaluate VTE but do not report any difference based on tourniquet use.
References:
1. Britt CJ, Hwang MS, Vila PM, et al. Tourniquet use and factors associated with hematoma formation in free tissue transfer. Am J Otolaryngol. 2020;41(3):102404. doi:10.1016/j.amjoto.2020.102404
2. Saleh E, Saleh J, Govshievich A, Ferland-Caron G, Lin JC, Tremblay DM. Comparing Minor Hand Procedures Performed with or without the Use of a Tourniquet: A Randomized Controlled Trial. Plast Reconstr Surg Glob Open. 2021;9(4):e3513. doi:10.1097/GOX.0000000000003513
3. Drolet BC, Okhah Z, Phillips BZ, et al. Evidence for safe tourniquet use in 500 consecutive upper extremity procedures. Hand (N Y). 2014;9(4):494-498. doi:10.1007/s11552-014-9667-1
4. Omeroğlu H, Uçaner A, Tabak AY, Güney O, Biçimoğlu A, Günel U. The effect of using a tourniquet on the intensity of postoperative pain in forearm fractures. A randomized study in 32 surgically treated patients. Int Orthop. 1998;22(6):369-373. doi:10.1007/s002640050280