THE EFFECTS OF CONSTRICTION AND RELEASE OF AN EXTREMITY

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Abstract
Tourniquets have long been used for the temporary control of bleeding from traumatic wounds of the extremities, and chiefly since the time of von Esmarch,1 to render an extremity relatively bloodless during surgical operations on it. In both instances it is of importance to know how long the constrictor may be left in place with safety to the patient. Various limits have been placed on this period of safety; commonly it is from 1½ to 2½ hours,2 although there are isolated examples of longer constrictions without injury.3 The most obvious danger of prolonged constriction is that of interference with the nutrition of the part sufficient to cause subsequent gangrene. Paralysis of the extremity and Volkmann's ischemic contracture are occasionally described4 as a result of constriction, although Brooks5 was unable to produce experimental contractures by long periods of ligation. Since the paralyses may occur after relatively

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