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Thu Apr 19 02:47:26 BST 2007

Jacob,

You raise a question that has two answers, as yours is two questions:

If you have to amputate in the field, do you use a TQ?
This is my opinion, and I've only seen it done once, on a farm, leg in a floor auger:  A TQ was used.  Now, I'll give you MY opinion should I (as a trauma surgeon) ever be called to do this.  My answer is yes.  It should lessen bleeding.  Having done many amputations under controlled OR circumstances, with and w/o TQ, I like the latter.  It's a bloody mess and, in the field, is going to be a bigger, bloodier mess.

If the amputation has occurred, would I use a TQ?

Depends.  I've seen traumatic amps that did so much vessel damage that there wasn't a whole lot of bleeding.  I've seen them that bled like a stuck hog.  What I think is very important, and this is something I've seen twice, is to put the TQ as far distal as possible so that you have some viable tissue proximally (what will become the distal stump).  I had a guy with a traumatic amp whose injury was just below the elbow.  A very tight BP cuff was applied at the mid-arm (humerus) and everything beneath the cuff and distal to it was DEAD dead (we got him several hours later due to weather and his warm ischemia time was 4 or more hours)...he ended up, ultimately with a forequarter amputation.  Had the TQ been applied more distally, we could've probably save the elbow and just distal to it for a nice stump to work with.

Hope that helps.  And, this is one man's opinion.  I don't think many out there, who aren't military, will have much cumulative experience, but I'll be interested to hear.

RD
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