THE SAFETY OF THE ESMARCH TOURNIQUET

The use of an Esmarch bandage as a tourniquet in surgery has been crit icized. Many authors claim that the pressures under the Esmarch are in consistent and may be extremely high. We have seen few, if any, proble ms from the use of an Esmarch in surgery of the foot and ankle. The pu rpose of this study was to evaluate the pressures generated under the Esmarch tourniquet in a situation that mimics its clinical application , and to determine whether pressures of appropriate magnitude and cons istency are obtained in order to recommend its continued use in surger y. Ten volunteers performed numerous applications of the Esmarch. The number of wraps and the width of the Esmarch bandage used were varied. The Esmarch was applied as it would be for a surgical case. Pressures directly beneath the Esmarch were recorded 8 cm proximal to the dista l tip of the medial malleolus. Considering all volunteers and all pres sures generated, a 3-in Esmarch applied with three wraps gave a mean p ressure (+/- SD) of 225 +/- 46 mm Hg. A 3-in Esmarch applied with four wraps gave a mean pressure of 291 +/- 53 mm Hg. A 4-in Esmarch applie d with three wraps gave a mean pressure of 233 +/- 35 mm Hg, and a 4-i n Esmarch with four wraps gave a mean pressure of 284 +/- 42 mm Hg. Th e maximum pressures generated by any individual were as follows: 3-in three wraps, 321 mm Hg; 3-in four wraps, 413 mm Hg; 4-in three wraps, 328 mm Hg; and 4-in four wraps, 380 mm Hg. There was no significant di fference in the magnitude or consistency of pressures generated betwee n the experienced and inexperienced wrappers. There did not appear to be a learning curve for the application of the Esmarch bandage. We con clude that an Esmarch bandage, used as a tourniquet, can generate safe and reliable pressures. Either a 3-in or 4-in Esmarch bandage applied above the ankle with three circumferential overlapping wraps consiste ntly results in pressures that are in a safe range.