Arch Hand Microsurg.  2018 Dec;23(4):313-318. 10.12790/ahm.2018.23.4.313.

Two Cases of Pneumatic Tourniquet Paralysis: Points for Prevention

• Kim H
• Kim YH

• KMID: 2427401
• DOI: http://doi.org/10.12790/ahm.2018.23.4.313

Abstract

Although nerve injury is the most common complication of pneumatic tourniquets, it is said to be rare, with few case reports. We describe two cases of paralysis after upper extremity surgery to highlight this risk. Ulnar, median and radial neuropathies were diagnosed after surgery was performed on a man for left hand reconstruction, presumably due to a prolonged total inflation time of 14 hours despite conventional break times. A woman who received surgery for a crushed hand presented with radial neuropathy, the most probable cause being malfunction and automatic inflation of the tourniquet. These cases illustrate the diversity of tourniquet paralysis, with symptomatic progress not necessarily following electromyography results. The considerable discomfort to patients warrants careful use of tourniquets for neuropathy prevention.

Keyword

Upper extremity; Radial neuropathy; Ulnar neuropathy; Tourniquet

MeSH Terms

Electromyography
Female
Hand
Humans
Inflation, Economic
Paralysis*
Radial Neuropathy
Tourniquets*
Ulnar Neuropathies
Upper Extremity

Figure

• 

  Fig. 1 Multiple Z-plasties for scar contracture release, neurolysis, Hunter rod insertion, pulley reconstruction, and osteotomy with autologous bone grafting were performed on a 33-year-old male for secondary hand reconstruction, which amounted to a total operative time of 17 hours (Case 1).

• 

  Fig. 2 After a prolonged free flap surgery of 19 hours, during which a tourniquet was inflated for less than two hours, wristdrop and loss of finger extension accompanied by sensory change appeared in a 45-year-old woman (Case 2).

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  Fig. 3 One year later, with conservative treatment, the patient had almost fully recovered motor function except for joint stiffness in the reconstructed finger. Clinical improvement preceded recovery of electromyography results.

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