Prolonged Tourniquets: Ischemia, Reperfusion and Compartment Syndrome

A tourniquet may stop catastrophic bleeding, but prolonged ischemia creates a new set of surgical problems. This lecture follows that transition: from tourniquet duration and tissue-level injury to reperfusion, limb viability, renal complications and the decision between salvage and amputation.

The discussion connects published military and civilian evidence with Ukrainian combat experience that is already influencing NATO and Tactical Combat Casualty Care thinking. Particular attention is given to patients arriving after several hours of tourniquet time, assessment of muscle viability, controlled tourniquet release and strategies used when reperfusion itself becomes dangerous.

The second half moves into compartment syndrome and fasciotomy. Lower-leg and thigh compartments, surgical landmarks, commonly missed releases and practical checks for a complete decompression are reviewed alongside lessons from Iraq and Afghanistan. The Q&A then tackles the cases that rarely fit a clean algorithm: partial fasciotomy, delayed compartment syndrome, venous tourniquets and localized pressure necrosis beneath an excessively tight tourniquet.