Plasma flow distal to tourniquet placement provides a physiological mechanism for tissue salvage

Military literature has demonstrated the utility and safety of tourniquets in preventing mortality for some time, paving the way for increased use of tourniquets in civilian settings, including perioperatively to provide a bloodless surgical field. However, tourniquet use is not without risk and the...

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Bibliographic Details
Published in:PloS one 2020-12, Vol.15 (12), p.e0244236-e0244236
Main Authors: Busse, Emily, Hickey, Cheryl, Vasilakos, Nicole, Stewart, Kennon, O'Brien, Fred, Rivera, Jessica, Marrero, Luis, Lacey, Michelle, Schroll, Rebecca, Van Meter, Keith, Sammarco, Mimi C
Format: Article
Language:English
Subjects:
Adolescent
Adult
Animal euthanasia
Animal models
Animals
Antiinfectives and antibacterials
Biology and Life Sciences
Emergency medical care
Extremities - blood supply
Female
Flow
Health sciences
Humans
Hypoxia
Hypoxia - physiopathology
Infrared imaging
Ischemia
Ischemia - therapy
Limb salvage
Male
Medicine
Medicine and Health Sciences
Methods
Mice
Microcirculation
Microorganisms
Middle Aged
Muscles
Neutrophils
Orthopedics
Oxygen
Oxygen - metabolism
Patient outcomes
Physical Sciences
Plasma
Recovery
Reperfusion Injury - therapy
Research and Analysis Methods
Surgery
Swine
Tissues
Tourniquets
Tourniquets - statistics & numerical data
Young Adult
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Summary:Military literature has demonstrated the utility and safety of tourniquets in preventing mortality for some time, paving the way for increased use of tourniquets in civilian settings, including perioperatively to provide a bloodless surgical field. However, tourniquet use is not without risk and the subsequent effects of tissue ischemia can impede downstream rehabilitative efforts to regenerate and salvage nerve, muscle, tissue and bone in the limb. Limb ischemia studies in both the mouse and pig models have indicated not only that there is residual flow past the tourniquet by means of microcirculation, but also that recovery from tissue ischemia is dependent upon this microcirculation. Here we expand upon these previous studies using portable Near-Infrared Imaging to quantify residual plasma flow distal to the tourniquet in mice, pigs, and humans and leverage this flow to show that plasma can be supersaturated with oxygen to reduce intracellular hypoxia and promote tissue salvage following tourniquet placement. Our findings provide a mechanism of delivery for the application of oxygen, tissue preservation solutions, and anti-microbial agents prior to tourniquet release to improve postoperative recovery. In the current environment of increased tourniquet use, techniques which promote distal tissue preservation and limb salvage rates are crucial.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0244236