Four weeks after the earthquake in Kashmir, multidisciplinary surgical teams were organised within the UK (MiST). The aim was to help with disaster victims who had been transferred to Rawalipindi. We reviewed the work carried by one such team from the 5-18 November 2005. There were 78 patients: 50 lower limb injuries only, 21 upper limb, 7 combined, injuries. Mean age was 24 (0.5-80). 24 patients were under 10 and only 5 over 60. 274 procedures were performed over 11 days (average 25 per day).Introduction
Patients
We report the effect of padding on the efficiency of the pneumatic tourniquet for the upper limb. Varying thicknesses of two commercially-available types of orthopaedic padding (Cellona and Velband) were applied to the arms of 20 volunteers, with three pressure transducers placed directly beneath the padding. A tourniquet was positioned over the padding and inflated to 220 mmHg. Significant reductions in the transmitted pressure were recorded from the transducers with both padding materials. With eight layers of padding, reductions in pressure of 13% (1% to 26%) and 18% (7% to 35%) were seen with Cellona and Velband, respectively. The reduction in pressure with Velband padding correlated with increasing arm circumference (Pearson’s correlation coefficient 0.711, p <
0.001). Studies to date have examined how arm circumference affects the required tourniquet inflation pressure. Our study is the first to investigate the effect of the padding and the findings suggest that using more than two layers results in a significant reduction in the transmitted pressure.
