The Use of the S-MART Tourniquet in Hand Surgery: A Safe and Effective Way to Provide a Bloodless Field

We have retrospectively reviewed our use of the S-MART sterile silicon ring self-exsanguinating tourniquet in 300 consecutive minor hand surgical procedures. A total of 3 postoperative complications were identified, only 1 of which was directly related to the tourniquet’s use. We outline the reasons of why we feel that this device provides a safe and effective bloodless field and the benefits of its use. 1. Introduction The S-MART tourniquet (OHK Medical Devices, Newark, NJ) is a novel single-use tourniquet, which provides exsanguination of the limb, arterial occlusion, and application of sterile stockinet in one device. Its use in extremity surgery has been documented, but the largest series to date has been 51 patients [1, 2]. The S-MART tourniquet works by virtue of a core silicon ring which provides the pressure required to expel luminal blood during application and maintain arterial occlusion throughout the procedure once in situ. This ring is wrapped in sterile stockinet with pull handles attached to facilitate application. Figure 1 shows a cross section of the S-MART and Figure 2 shows its application. Figure 1: Cross section of the S-MART tourniquet. Figure 2: S-MART after application. In a recent article, Noordin et al. [3] criticized the use of nonpneumatic ring type tourniquets such as the S-MART in nonbattlefield settings claiming that their use may increase the occurrence of tourniquet-related adverse events. The article discussed two particular adverse events: tourniquet-related nerve injury and skin blistering. We have been using the S-MART tourniquet for all appropriate hand and wrist procedures in our day surgery department for a number of years; anecdotally we have not noticed any increase in the complications suggested by Noordin et al. and thus felt it would be worthwhile to review a cohort of patients to ensure this was the case; we report our experience. 2. Methods Our cohort included the last 300 patients undergoing one of the 4 most common procedures in our department: carpal tunnel decompression, De Quervain’s decompression, trigger finger release, and ganglion excision with a minimum of 6-month follow-up (prior to January 2010). Exclusion criteria were incomplete notes, no documented postoperative follow-up, inability to use S-MART tourniquet (limb circumference too great), and preexisting soft tissue damage or neurological lesion (other than carpal tunnel syndrome) affecting the limb concerned. All procedures were carried out under the supervision of the senior author (P. Davey); 50 patients were excluded (47 missing or