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

## TL;DR

Using a pneumatic tourniquet during calcaneal fracture surgery reduces deep soft-tissue blood flow and oxygenation but does not delay wound healing.

## Contribution

Demonstrates that tourniquet use affects microcirculation but not wound healing in calcaneal fractures.

## Key findings

- Tourniquet use significantly reduced blood flow and tissue oxygenation at 8 mm depth.
- No significant impact on postoperative wound healing time was observed.
- Microcirculation changes were measured using non-invasive spectrophotometry.

## Abstract

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.

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 (SO2[%]) 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.

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.

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).