• Alexandre Sabate-Ferris, Georges Pfister, Guillaume Boddaert, Jean-Louis Daban, Stéphane de Rudnicki, Alexandre Caubere, Thomas Demoures, Stéphane Travers, Fréderic Rongieras, and Laurent Mathieu.
• Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, Clamart, France.
• Eur J Trauma Emerg Surg. 2022 Oct 1; 48 (5): 3847-3854.

PurposeThis study reports on complications following extended tourniquet application in patients with combat extremity injuries treated by the French Military Health Service in the Sahelian strip.MethodsA retrospective review was performed in a French forward medical treatment facility deployed in Gao, Mali, between 2015 and 2020. All patients treated for an extremity injury with the application of at least one tourniquet for a minimum of 3 h were included. Prehospital data were injury pattern, associated shock, tourniquet location, and duration. Subsequent complications and surgical procedures performed were analyzed.ResultsEleven patients with a mean age of 27.4 years (range 21-35 years) were included. They represented 39% of all patients in whom a tourniquet was applied. They had gunshot wounds (n = 7) or multiple blast injuries (n = 4) and totaled 14 extremity injuries requiring tourniquet application. The median ISS was 13 (interquartile range: 13). Tourniquets were mostly applied proximally on the limb for a mean duration of 268 min (range 180-360 min). Rhabdomyolysis was present in all cases. The damage control surgeries included debridement, external fixation, vascular repair, and primary amputation. Ten injuries were complicated by compartment syndrome requiring leg or thigh fasciotomy in the field or after repatriation. Two severely injured patients died of their wounds, but the others had a favorable outcome even though secondary amputation was sometimes required.ConclusionsExtended and proximal tourniquet applications led to significant morbidity related to compartment syndrome and rhabdomyolysis. Hemorrhagic shock, mass casualty incident, and tactical constraints often precluded revising the temporary tourniquet applied under fire.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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