Hemostasis and tourniquet

Achieving hemostasis is vital for any surgical procedure. Modern techniques of hemostasis have revolutionized extremity surgery. Achieving a bloodless field allows for the execution of more complex procedures in terms of the ease of anatomic dissection and minimizing the length of surgery. Strategies to achieve hemostasis start before the incision with purposeful preoperative planning and the use of a tourniquet. Although the tourniquet is thought to be vital in extremity surgery, it is not without complication. Ischemic damage to muscle, pressure damage to nerves, and the systemic effects of reperfusion all limit the duration of its use and introduce potentially significant complications. Once bleeding is encountered, hemostasis can be obtained using various techniques. Direct pressure is the simplest method of controlling bleeding and can also be used to gain necessary time to mobilize other agents or methods in a life-threatening situation. The electrocautery device, similar to the tourniquet, is an important component but can introduce potentially devastating complications. A thorough understanding of how the device works is necessary in preventing these complications. Finally, a large variety of hemostatic agents exist to aid in achieving coagulation via both mechanical and chemical methods.