The Journal of hand surgery
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Previous recommendations regarding the "safe" period of tourniquet hemostasis were based largely on studies of ischemia distal to the tourniquet. This study quantitatively analyzed skeletal muscle injury induced beneath and distal to a pneumatic tourniquet applied to the hindlimbs of rabbits for 1, 2, or 4 hours with a cuff inflation pressure of 125, 200, or 350 mm Hg. Technetium Tc 99m pyrophosphate incorporation after systemic injection (Tc 99 uptake) and correlative histology were used to evaluate tissue damage 2 days after tourniquet application. ⋯ Focal and regional fiber necrosis and degeneration were observed in thigh muscles after 2 hours of tourniquet compression. Two hours of continuous tourniquet application at clinically relevant cuff inflation pressures induced significant skeletal muscle necrosis beneath the tourniquet. Use of the lowest possible inflation pressure for a limited duration should minimize the degree of tissue injury caused by tourniquet application.