The efficacy of the tourniquet in foot and ankle surgery? A systematic review and meta-analysis☆☆☆

Tourniquets are commonly used during foot and ankle surgery. The purpose of this study was to compare the peri- and post-operative outcomes of tourniquet-assisted to non-tourniquet-assisted ankle and foot surgery. A systematic review was undertaken assessing the electronic databases Medline, CINAHL, AMED and EMBASE, in addition to a review of unpublished material and a hand search of pertinent orthopaedic journals. The evidence-base was critically appraised using the Cochrane Bone, Joint and Muscle Trauma Group quality assessment tool. Study heterogeneity was measured using χ2 and I2 statistics. Where appropriate, a random-effects meta-analysis was undertaken to pool results of primary studies, assessing mean difference or relative risk of each outcome. A total of four studies were identified. The findings of this study would suggest that hospital length of stay was significantly shorter, and that the post-operative period was less painful, with reduced swelling from the fifth post-operative day, in surgeries undertaken without a tourniquet, compared to tourniquet-assisted procedures. There may be a greater incidence of wound infection and deep vein thrombosis in tourniquet-assisted foot and ankle procedures. The methodological quality of the evidence base is limited. Further study is required to address these limitations, after which we may be able to determine whether a tourniquet should be used during ankle or foot procedures.