Microvascular surgery in a bloodless field

Although tourniquets play an integral role in extremity surgery, no clear g uidelines exist for the use of tourniquets in microsurgery. We undertook a study in 12 healthy volunteers to better understand the coagulation propert ies of blood distal to an inflated tourniquet. At a 15-min inflation time, blood distal to an inflated tourniquet clots faster than blood taken from t he opposite arm after addition of exogenous thrombin (12.5 s vs 17.5 s, P < 0.0001). Neither fibrinopeptide A (FPA) levels nor tissue plasminogen acti vator (tPA) levels were different from those of controls. Tissue factor pat hway inhibitor (TFPI), an endogenous local anticoagulant, was slightly but significantly elevated in tourniquet blood. Although much remains to be und erstood, we believe that microvascular surgery in a bloodless field is safe and efficacious. Nine patients are presented who successfully underwent mi crovascular surgery in a bloodless field, using various types of extremity tourniquets. (C) 2000 Wiley-Liss, Inc.