Description

A 75-year-old man underwent routine left total knee arthroplasty under a spinal anaesthetic. An adequately sized pneumatic tourniquet with wool padding was used and a clear adhesive drape applied circumferentially around the thigh to isolate the tourniquet. A 10% w/w povidone-iodine solution had been used to prepare the left leg. The tourniquet was inflated just prior to cementation of the implants with a tourniquet time of 40 min. The total operative time was 95 min. The patient began to report thigh pain the following day. Examination of the thigh revealed erythema similar to the pattern of povidone-iodine staining with areas of blistering (figures 1 and 2) over the anterior and lateral thigh. Pain symptoms had resolved by day 4 postoperatively and the blisters had fully resolved by the 6-week outpatient review.

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Figure 1

Clinical photograph of the anterior thigh demonstrating a large blister (white arrow).

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Figure 2

Clinical photograph of the lateral thigh demonstrating multiple blisters (white arrows) and linear areas of erythema.

Tourniquet-associated complications include postoperative pain and swelling, injury to skin, nerves and vessels, necrosis of digits and compartment syndrome.1 Chemical burns as a result of impregnation of the tourniquet padding with the chemical agents used for skin preparation have been previously reported and are rare.2 ,3 They can cause blistering, as in our case, which resolves within a few weeks, or progress to full-thickness injuries that can take several months to heal.3 A waterproof barrier is recommended to isolate the tourniquet to prevent such injuries.3 The adhesive drape used routinely to prevent such burns had likely peeled away in places during the preparation of the limb for surgery allowing for the pooling and impregnation of the cast padding.