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elastic bandage, hyperoxygenated fatty acids, skin lesion, surgical pneumatic tourniquets



  1. Castillo Martin, Beatriz
  2. Castillo Martin, Juan Ignacio MD
  3. Lago Oliver, Jesus
  4. Diz Gomez, Jorge


OBJECTIVES: To determine whether hyperoxygenated fatty acids (HOFAs) provide safe and effective protection against lesions caused by surgical pneumatic tourniquets (SPTs).


METHODS: This was a nonrandomized, single-blind, 2-arm, prospective, comparative study. The study was approved by the Ethics and Clinical Research Commission of the Hospital Universitario Gregorio Maranon, in Madrid, Spain. Subjects in the intervention group were treated topically with HOFAs (Linovera; B. Braun Medical Inc, Bethlehem, Pennsylvania) at the site (upper and lower limbs) where an SPT was to be applied. An elastic bandage was then set in place and finally the SPT. Control subjects were treated in the same way, but no HOFAs were applied.


PARTICIPANTS: The study subjects were all patients of the Department of Orthopedic and Trauma Surgery at the Hospital Universitario Gregorio Maranon for whom the use of an SPT was indicated for 60 minutes or longer. In total, 174 patients completed the study, 83 in the HOFA-treatment arm and 91 in the control arm. All subjects gave their informed consent to be included.


MAIN OUTCOME: Assessment of the lesions induced by the SPT after its removal.


MAIN RESULTS: Significant correlations were found between the risk of developing lesions and age 70 years or older (P = .021), a duration of ischemia of 70 minutes or longer (P = .006), and being a member of the control group (P < .001). Some 93.4% of the intervention group experienced only a grade 0 to 1 skin lesion compared with 55.4% of the control group. Moreover, 44.6% of the control arm subjects suffered a grade 2 to 4 lesion compared with only 6% of the HOFA-treated subjects. No subject in the treatment arm suffered any important skin lesion; in the control arm, however, 2 patients suffered edema, another suffered induration, and 2 experienced abrasions.


CONCLUSIONS: The use of topical HOFAs, in conjunction with the application of an elastic bandage before applying an SPT, is a safe and effective way of preventing SPT-induced skin lesions.