Tourniquet Use is Not Associated with Limb Loss Following Military Lower Extremity Arterial Trauma

Background The effect of battlefield extremity tourniquet (TK) use on limb salvage and long-term complications following vascular repair is unknown. This study explores the influence of TK use on limb outcomes in military lower extremity arterial injury. Methods The study database includes cases of lower extremity vascular injury from 2004-2012 with data recorded until discharge from military service. We analyzed all limbs with at least one named arterial injury from the femoral to the tibial level. TK and no TK (NTK) groups were identified. Univariate analyses were performed with significance set at P≤0.05. Results 455 cases were included, with 254 (56%) having a TK for a median of 60 min (8-270 min). Explosive injuries (53%) and gunshot wounds (26%) predominated. No difference between TK and NTK was present in presence of fracture, level of arterial injury, type of arterial repair, or concomitant venous injury. More nerve injuries were present in the TK group and AIS-Extremity and MESS tended towards greater injury severity. Amputation and mortality rates did not differ between groups but the incidence of severe edema, wound infection, and foot drop was higher in the TK group. Vascular above-knee amputation, arterial repair complication, and severe edema were higher in the TK group also (P=.10). TK duration of ≥ 60 minutes was not associated with increased amputations but more rhabdomyolysis was present. Conclusion Field TK use is associated with wound infection and neurologic compromise but not limb loss. This may be due to a more severe injury profile among TK limbs. Increased tourniquet times may predispose to systemic, but not limb complications. The authors have no financial or other conflicts of interest. Corresponding Author; David S. Kauvar, MD, FACS, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, davekauvar@gmail.com, lynddl@hotmail.com, thomas.j.walters 22.civ@mail.mil The assertions and opinions contained herein are solely those of the authors and do not represent those of the United States Army, the Department of Defense, or any other official entity. This study was conducted under a protocol reviewed and approved by the US Army Medical Research and Materiel Command Institutional Review Board and in accordance with the approved protocol The authors acknowledge Dept. of Defense Trauma Registry (DoDTR) and Patient Administration Systems & Biostatistics Activity (PASBA) for providing data for this study. © 2018 Lippincott Williams & Wilkins, Inc.

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