Please note: In any event, the values of pressure and model selection in the Model Selection Guide are to be used as reference.
Melamed E, et al., Rambam Medical Center and the Rappaport Faculty of Medicine, Technion, Haifa, Israel, Presented at the ACFAS conference in Long Beach USA, 2008.
We report our recent experience with a new SET device (HemaClear®, OHK Medical Devices, Haifa, Israel) during foot & ankle surgical procedures. HemaClear® was used in all of the procedures in order to save OR time and achieve a blood less field. The HemaClear® consists of an elastic (silicone) ring wrapped around with a long sleeve (stockinet) and straps. When the straps are pulled, the ring rolls up the limb quickly and easily while effectively expelling the blood (venous, arterial and capillary) from the limb. The ring is tight enough to block the arterial blood reentry into the limb. Being a single-patient sterile device, the tourniquet ring can be placed just proximal to the surgical incision (thus limiting the volume of ischemic tissue) and also applied only late in the procedure on an as-needed basis (thus limiting the ischemia duration). If the procedure is too long, the HemaClear® can be removed and after sufficient time for re-perfusion, a second HemaClear® can be applied.
We performed moderate to high complexity F&A procedures. 11 feet were operated in 10 patients: Tarsal coalition (n=4, three patients, one bilateral), acquired flat due to Tibialis Posterior Tendon insufficiency treated by calcaneous + cotton osteotomies and Flexor Digitorum Longus transfer (n=2), Peroneal tendon surgery (n+2), revision of Achilles tendon release and lengthening following combat injury (n=1), Hallux Rigidus interpositional arthroplasty (n=1) and one anterior ankle cheilectomy (n=1). HemaClear® was used in all cases. In 2 cases we removed the device and re-applied a second one due to the length of the operation. Application time was less than one minute in all cases.
There is slight difficulty in rolling the device across the heel-ankle region, which is the widest part of the foot, but this has not been a problem after the second procedure. Exsanguination was practically perfect; yielding a completely dry (bloodless) surgical field diminishing the need for
sponging, suctioning and cauterization during the bulk of the procedure. There were no complications and the tourniquet was well tolerated by the patients, when ankle block was applied.
CONCLUSIONS: The HemaClear® SET represents an efficient and safe substitution for the traditional pneumatic tourniquet and/or the Esmarch Bandage. It saves application time and can be applied over an open incision due to its sterility. It provides a bloodless field without leg
elevation. It can be rolled up to the desired level according to the surgical exposure. No complications or adverse effects were observed.