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Optimizing theBloodlessSurgical FieldinLimbSurgery Noam Gavr i ely, md, ds c L E A R N I N G O B J E C T I V E S s Read about the history of bloodless limb surgery s Explain the different tourniquet styles mentioned in this article s Review how the pathophysiology of the skin, muscles and nerve compression are impacted by tourniquets s Describe the importance of completely exsanguinating the limb before a tourniquet is used s Compare and contrast patient safety with economic advantages between the two tourniquet styles The incidence of post-operative skin injuries and blisters is reported 8 in 20.7% of TKA cases using a state-of-the-art pneumatic tourniquet. The same study reports 39.7% of patients having significant thigh pain on day 4 post-operatively and one case of nerve injury among the 160 patients. A concerning practice is the re-use of non-sterile cuffs in many of the US hospitals and ASCs that perform limb operations which likely contribute to the incidence of SSIs. An alternative safe and effective Surgical Exsanguination Tourniquet (SET) is now used in over 500 hospitals in the US with superior exsanguination, sim- pler OR logistics and most importantly, an impeccable patient safety track record. Multiple investigator-initiated studies published in peer- reviewed journals report no skin or nerve damage, significantly less pain, much reduced intra-operative blood loss, less SSI, less DVT and longer auto-graft harvesting for ACL reconstruction. Limb surgery under a bloodless field is performed approximately 3,000,000 times a year (10,000 cases a day) in the US. The historical method of using an Esmarch bandage and a pneumatic tourniquet, first introduced in 1873 and 1904, respectively, dominates the prac- tice, despite a high rate of adverse events and complications. JANUARY 2022 | The Surgical Technologist | 15