The use of tourniquets in the excision of unexsanguinated extremity burn wounds

Purpose: Tangential excision of burns is complicated by blood loss. Tourniquet use decreases blood loss, but adequacy of excision has been questioned. An attempt was made to assess the value of not exsanguinating the limb prior to tourniquet inflation to improve visualization of bleeding points and subsequent engraftment. Methods: Eleven excisions of bilateral extremity wounds were performed. One limb was excised without the benefit of a tourniquet, the other with tourniquet but without exsanguination. Tangential excision was performed, hemostasis achieved, and blood loss quantified. Engraftment of skin was assessed at first dressing change and at initial follow-up after discharge. Results: Area of burn was the same, 4.8% with tourniquet, 5.1% without (P=0.38). Overall blood loss was less with tourniquet control, 100–259 cm3 (P=0.002); as was blood loss per area, 0.19–0.58 cc/cm2 (P=0.04). Graft take was similar, 98.2% early and 98.1% later with tourniquet, with 98.2 and 96.8% take without (P>0.1). Conclusions: Tourniquet use in the unexsanquinated extremity reduced blood loss without affecting engraftment.