English Ukrainian
Clinical medicine

DAMAGE CONTROL TOURNIQUET AS A COMPONENT OF DAMAGE CONTROL SURGERY IN ISCHEMIA-REPERFUSION SYNDROME

Published 2026-09-30

Authors:

Khoroshun E.M.
Kharkiv National Medical University image/svg+xml
https://orcid.org/0000-0003-1258-1319
Panasenko S.I.
Poltava State Medical University image/svg+xml
https://orcid.org/0000-0003-2952-1670
Negoduiko V.V.
Kharkiv National Medical University image/svg+xml
https://orcid.org/0000-0003-4540-5207
Shypilov S.A.
Kharkiv National Medical University image/svg+xml
https://orcid.org/0000-0002-1689-2213
Klapchuk Y.V.
Military Medical Teaching Center of the Northern Region of Ministry of Defense of Ukraine
https://orcid.org/0000-0003-1903-959X
Kupriyanchuk V.V.
Military Medical Teaching Center of the Northern Region of Ministry of Defense of Ukraine
https://orcid.org/0009-0003-7478-4813
Kerbazh N.R.
Poltava State Medical University image/svg+xml
https://orcid.org/0000-0002-7722-9896
Abstract:
Severe ischemia-reperfusion syndrome in physiologically unstable patients with nonviable extremities remains a major challenge in damage control surgery. We analyzed 31 cases of tourniquet use aimed at preventing this syndrome in physiologically unstable patients with nonviable extremities treated in our center. Clinical, laboratory, imaging, intraoperative, and microcirculatory assessments were used to evaluate limb viability and guide surgical management. We propose the term damage control tourniquet (DACOTa) for planned tourniquet maintenance or application as a bridging strategy before life-saving amputation. This strategy was used in 5.7 % of tourniquet cases; lower extremity injuries predominated (78.9 %). Previously applied hemorrhage-control tourniquets were maintained in 74.2 % of cases. Thirty-one amputations were performed in 28 patients, predominantly as single-stage procedures (83.9 %). Overall mortality was 38.7 %, mainly due to post-resuscitation syndrome and multiple organ failure. The damage control tourniquet provides an effective bridging strategy, enabling definitive amputation after physiological stabilization and improving clinical classification of tourniquet use.
Keywords:
hemorrhage-control tourniquet damage control tourniquet tourniquet syndrome ischemia-reperfusion syndrome combat-related extremity trauma
References:
  1. Akrivos VS, Koutalos A, Stefanou N, Koskiniotis A, Arnaoutoglou C. Crush injury and crush syndrome: a comprehensive review. EFORT Open Rev. 2025 Jun 2;10(6):424-430. doi: 10.1530/EOR-2025-0055.
  2. Bedri H, Ayoub H, Engelbart JM, Lilienthal M, Galet C, Skeete DA. Tourniquet Application for Bleeding Control in a Rural Trauma System: Outcomes and Implications for Prehospital Providers. Prehospital Emergency Care, 2022;26(2):246–254. DOI: 10.1080/10903127.2020.1868635
  3. Butler F, Holcomb JB, Dorlac W, Gurney J, Inaba K, Jacobs L et al. Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war. J Trauma Acute Care Surg. 2024 Aug I ;97(2S Suppl l):S45-S54. Epub 2024 Jul 12. DOI: 10.1097/ TA.0000000000004395
  4. Guryev SO, Kushnir VA, Solovyov OS, Panasenko SI. Substantiation of indications for limb amputation in civilian victims with multisystem injuries as a result of modern warfare. Ukrainian Journal of Clinical Surgery. 2025 Jan-Feb;92(1):49-54. DOI: 10.26779/2786-832X.2025.1.49.
  5. Hoey BA, Schwab CW. Damage control surgery. Scand J Surg. 2002;91(1):92-103. DOI: 10.1177/145749690209100115.
  6. Johansson L, Wild H, O'Marr J, Nacanabo YA, Zeba ZA, Sanou Y et al. Assessing Evidence Bias for Prehospital Tourniquet Use: A Scoping Review. World J Surg. 2025;49:1471-1483. DOI: 10.1002/wjs.12596
  7. Katzir A, Krispel J, Acker A, Jammal M, Mosheiff R, Liebergall M et al. Outcomes of Prolonged Tourniquet Application on the Battlefield: Is a Liberal Application Policy Always Justifiable?. Journal of Orthopaedic Trauma. 2026;40(1):44–50. DOI: 10.1097/BOT.0000000000003089
  8. Li W, Liao Y, Chen J, Kang W, Wang X, Zhai X et al. Ischemia - Reperfusion injury: A roadmap to precision therapies. Mol Aspects Med. 2025 Aug;104:101382. DOI: 10.1016/j.mam.2025.101382
  9. Masry MS, Gnyawali SC, Sen CK. Robust critical limb ischemia porcine model involving skeletal muscle necrosis. Sci Rep 13, 11574 (2023). DOI: 10.1038/s41598-023-37724-7
  10. Medby C, Ricks J, Ingram B, Forestier C, Parkhouse D, Gurney I et al. Removal of tourniquets: the next step in saving lives and limbs. BMJ Mil Health. 2025;171:288-289. DOI: 10.1136/military-2024-002785.
  11. Miyauchi H, Okubo K, Iida K, Kawakami H, Takayama K, Hayashi Y et al. Multiple site inflammation and acute kidney injury in crush syndrome. Front. Pharmacol. 2024;15:1458997. DOI: 10.3389/fphar.2024.1458997
  12. Nola IA, Dvorski M, Žižak M, Kuliš T. Crush syndrome in earthquakes - stay and play or load and go?. Acta Clin Croat. 2023;62(Suppl2):158-165. DOI: 10.20471/acc.2023.62.s2.24
  13. Stewart IJ, Faulk TI, Sosnov JA, Clemens MS, Elterman J, Ross JD et al. Rhabdomyolysis among critically ill combat casualties: Associations with acute kidney injury and mortality. J Trauma Acute Care Surg. 2016;80(3):492-498. DOI: 10.1097/TA.0000000000000933.
  14. Wolf JM, Mathieu L, Tintle S, Wilson K, Luria S, Vandentorren S et al. A global perspective on gun violence injuries. Injury. 2023;54(7): 110763. DOI: 10.1016/j.injury.2023.04.050.
  15. Xacur-Trabulce A, Casas-Fuentes G, Ruiz-Vasconcelos V, Reitz MM, Henry SM, Scalea TM et al. Tourniquet-related complications in extremity injuries: a scoping review of the literature. World J Emerg Surg. 2025;20:57. DOI: 10.1186/s13017-025-00625-3.
Publication:
«World of Medicine and Biology» Vol. 22 No. 97 (2026), pp. 156-160
UDC 617-001:616-036.88-047.44
DOI:
https://doi.org/10.26724/2079-8334-2026-3-97-156-160