The Impact of Tourniquet Release Time on Wound Healing in Patients Undergoing Tibia Fracture Plating Surgery

The use of tourniquet is very common in orthopedic surgeries. By obstructing blood flow in the limb, tourniquet may result in muscle ischemia and skin flap hypoxia. This study aimed at determining and comparing the effects of tourniquet release time on wound healing in patients undergoing tibia fracture plating surgery.
This study was a randomized clinical trial, wherein 40 patients with acute extra-articular tibia fractures were randomly assigned to 2 groups of A (releasing the tourniquet after fracture fixation and before wound closure) and B (releasing the tourniquet after wound closure and application of compression dressing). Duration of surgery in each group was recorded and independent t test was utilized to compare the 2 groups. The wound healing rate was investigated in the patients 24 hours and 14 days after surgery using the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale. In this tool, 0 represents “lack of the variable” and 3 indicates “maximum variable score”. The scores in this scale range from 0 to 15. The Mann-Whitney test was used in order to compare the wound healing rates between the 2 groups.
There was no significant difference between the 2 groups concerning the average duration of surgery. Wound redness, edema, ecchymosis, discharge, approximation, and the general condition of wound healing showed no significant difference in the 2 groups 24 hours after surgery, while there was a significant difference 14 days after surgery with the aforementioned parameters being greater in group B than group A.
The results showed that releasing the tourniquet before wound closure in group A led to improved wound healing. Wounds need oxygen for restoration and prevention from infections. As the use of tourniquet occludes blood flow to the limb for a while, it can result in increased wound hypoxia after surgery and delayed healing process; hence, less tourniquet time is more desirable for oxygenation of tissues and wound dryness.