Non muscle crushing Knee surgery 

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A tourniquet is a device that is designed to occlude blood flow. It applies pressure around blood vessels in order to close its channel. Traditionally during knee surgery, a tourniquet is applied to the thigh to occlude the blood supply to leg. Over two and a half times higher blood pressure (300mmHg) is applied around the thigh to stop the blood flow for 90 minutes. Although it reduces the blood loss from bone during surgery, it causes crush injuries to muscle, nerves, vessels and tendons. Furthermore, blood vessels can be injuried by the external crushing force and leads to blood clot formation and deep vein thrombosis. Once the tourniquet is released, the body will have to deal with the toxic waste from the limb which leads to a massive inflammatory response. Therefore it will lead to delayed recovery and thigh pain after surgery.

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Common problems with a tourniquet: 

1) Cause crush injuries to the nerve, tendon and muscle 

2) Damage to blood vessel wall and leads to deep vein thrombosis (DVT) and pulmonary embolism 

3) Leads to a massive inflammatory response after surgery

MSK Doctors have developed a pathway that eliminates the use of a tourniquet. By working with the anaesthetic and surgical team, we have been performing all routine knee surgery without the need of a tourniquet. This has significantly reduced thigh pain for our patients and improved their recovery following surgery. Most importantly patients were more satisfied following knee surgery without a tourniquet


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