From Big Medical Encyclopedia

PLAIT STYPTIC — adaptation for from pressure of the damaged main blood vessels on an extent for the purpose of a temporary stop of bleeding. to. it is applied also to reduction of blood loss at some operations, extensions of local and regional anesthesia, temporary switching off of an extremity from general circulation.

The temporary stop of bleeding by means of a plait is known from an extreme antiquity, and it is difficult to establish who possesses a priority of this offer. Also serious negative effects of a stop of bleeding using a plait were known: the large number of infectious complications of wounds, and in some cases and gangrene of an extremity was quite often observed. Possibly, in this regard for many decades numerous attempts to create an easy and portable design were made. to., edges would provide the minimum traumatizing fabrics, the dosed prelum, the bystry, not demanding great efforts imposing during the rendering a self-care and mutual assistance, low cost and a possibility of mass production. Set of these requirements turned a question about. to. in a serious problem, especially for military-medical service.

Fig. 1. Esmarkh's plait: a rubber tube (1) with a metal chain (2) and a hook (3) on the ends for fixing of the imposed plait.
Fig. 2. Winer's plait: a steel tape (1) with the screw (2) for fixing and dosing of compression of an extremity (below — a plait in unassembled form).

A large number of designs was offered. to., many of which have only historical interest. Treat them kompressoriya and a tourniquet with Lyuer's buckle, a screw tourniquet of Pti (1718), etc. In 1873 F. Esmarkh on the 2nd International congress of surgeons offered. to. from a rubber tube, on one of the ends the cut was fixed a metal hook, and on another — a metal chain (fig. 1). The same year B. Langenbek suggested to replace a rubber tube with a rubber tape that allowed to reduce several injuring action of a plait of Esmarkh by soft tissues and simplified technology of his imposing. In 1874 in the St. Petersburg medicochirurgical academy V. Efremov defended the dissertation on «About Desalination of Extremities for Operation by means of Elastic Bandage». In 1917 the domestic surgeon Winer offered a metal plait from a steel tape with adaptation allowing to dose compression of an extremity (fig. 2). Also other metal designs of sosudoszhimatel were offered. Many designers, hl. obr. abroad, in the models used rubber cuffs where the pump forced air. Pressure in them was controlled by the manometer. However these. to. did not gain wide recognition because of complexity of designs, bulkiness, difficulties of imposing and other shortcomings.

In 1931 and 1933 the international competition on the best design was announced. to., and in 1933 and 1938 such competitions were held in our country Research test sanitary in-volume of Red Army (NIISI RKKA). Despite it designs. to., not having serious shortcomings, it is not created, and work in this direction is continued.

Fig. 3. Burn down NIISI RKKA applied in days of the Great Patriotic War: 1 — a buckle; 2 — a loop for fixation of a stick; 3 — a stick for turning; 4 — a loop of turning; 5 — a band of a plait.

In days of the Great Patriotic War of 1941 — 1945 in field army Esmarkh's plait and a plait of a design made of cloth of NIISI RKKA (fig. 3) were applied. In the subsequent these plaits are removed from supply both in the Soviet Army, and in system of civil health care.

Fig. 4. The plait is rubber tape: a rubber tape (1) with a metal hook (2) and a metal chain (3) for fixing of the ends of the imposed plait.

With the advent of the top-quality rubber having good elasticity, resistance to low temperatures and not spoiling at storage on supply of the Soviet Army and civil health care rubber tape is accepted. to. This plait (fig. 4) represents a rubber tape 1250 mm long, 25 mm wide, 3 — 4 mm thick, is powerful apprx. 170 g. On one end of a tape there is a metal chain, and on another — a hook.

For imposing. to. on an extremity choose the place above a wound and is whenever possible closer to it that the part of an extremity deprived of blood supply was as it is possible well.

The plait can be imposed as on one-bone, and two-bone segments of extremities. On a shin and a forearm vessels are squeezed in interosseous space by muscles. It is necessary to avoid an applying a tourniquet in an average third of a shoulder since at the same time the beam nerve is injured, and also on a wrist and over anklebones because due to the lack of muscles in these areas it is possible to squeeze an artery not always, and under a plait the necrosis of skin quite often develops. Skin under. to. it has to be protected by a lining or clothes. The imposing plait is located from the outer side of an extremity, the plait brings from the inside. One hand take a plait for the end, and another — for its middle part. Stretch a rubber tape of a plait, wrap it around an extremity and tighten before the termination of bleeding from a wound or places of imposing are up to disappearance pulses lower. to. The subsequent tours are imposed with a smaller tension, however sufficient to interfere with relaxation of the first round. It is necessary to cover with each next tour of a plait partially previous that reduces danger of infringement and a necrosis of skin.

At an applying a tourniquet on a shin and a forearm it is tightened by several touch since because of a cone-shaped form of these segments of an extremity. to. can slide off, especially during the transportation of the wounded. Therefore in the battlefield it is necessary to prefer imposing. to. on a shoulder and a hip. It is less favorable, but it is technically simpler and more reliable.

Fig. 5. Imposing of a rubber ribbon yarn with the plywood tire by Gersh's method — Zhorova (for exemplariness the bandage is shifted).

The plait can be imposed with the plywood tire by Gersh's method — Zhorova (fig. 5). The plywood tire is imposed from outside, opposite to the damaged vascular bundle. Width of the tire shall be equal to diameter of a segment, and length is a little less than segment. This method of an applying a tourniquet is counted on creation of a possibility of collateral circulation in the drawn extremity.

At bleeding from the wound located in an upper third of a shoulder and an upper third of a hip, the plait is imposed in the form of the eight for what an upper third of an extremity is covered by 2 — 3 rounds of a plait. In the first case both ends are conducted in front of and behind a thorax and are fixed on the opposite side of a breast, and in the second — the eight covers a basin and vividly and the ends of a plait are fixed on the opposite side of a stomach, over an upper front awn of an ileal bone.

Fig. 6. An applying a tourniquet at damage of vessels of a neck at the left: 1 — a plait; 2 — a soft lining under a plait; 3 — the ladder tire folded double.

For a stop of bleeding at wound of a vascular bundle on a neck it is possible to impose a plait by means of the ladder tire. The tire put doubly is imposed from healthy side of a neck, rests against the head and a shoulder and serves as a framework, on Krom the plait stretches, squeezing a vascular bundle on the opposite side (fig. 6). Instead of the tire it is possible to use a hand of the most injured. For this purpose it is put on the head, and the shoulder is used instead of the tire.

Fig. 7. The improvised plait from a zone belt (across Entin).
Fig. 8. Imposing of the improvised plait — turning from a handkerchief with a soft lining (pilot) for the best prelum of the main vessels.

As improvised. to. it is possible to use a handkerchief, a kerchief, a scarf, a zone belt and so forth. to. from a zone belt on Entin's way impose in the form of a double loop (fig. 7) — in the beginning an external loop, and under it internal. It is possible to put a double loop in advance and to pass throughout it all extremity or to impose at first an external loop, and under it internal. The free end of a belt shall be in the right hand imposing a plait. During the tightening of a belt both loops move clockwise. The left hand shall fix clothes that it did not move together with a belt. A lack of this way is difficulty of removal of a belt, in particular at its namokaniye. At improvisation of a plait from a handkerchief, a kerchief and other make-shifts fabric is put in the form of a wide tape, a cut wrap an extremity. Previously on area of a vascular bundle impose the pilot from any dense material. The ends of a tape connect by two nodes, between to-rymi insert a strong wooden stick; rotation it is made a prelum of an extremity. The stick is fixed to an extremity a piece of bandage, a tape, etc. (fig. 8). It is inadmissible to use for a plait a rope, a telephone cable or other similar objects since they can strongly injure soft tissues. About time of an applying a tourniquet the mark, and also noticeable designation in clothes and in medical documents surely becomes. After an applying a tourniquet the victim needs to give drugs, to immobilize an extremity, in cold time to wrap up, but not to warm. It is necessary to evacuate wounded with the imposed plait in a prone position.

The wounded with imposed. to. it has to be immediately sent to medical establishment where bleeding can be stopped finally. Time, on a cut can be imposed a plait, shall not exceed the 2nd hour. At the same time each hour, and in winter time half an hour for partial recovery of blood circulation in the drawn extremity a plait at an opportunity it is necessary to weaken everyone for several minutes and then again to tighten. For this purpose above. to. make manual pressing of the main arterial vessel and only after that weaken a plait. If it lies more than 2 hours, then after relaxation the plait is shifted a little above.

At assistance to wounded in the battlefield (especially at most and mutual assistance) need of imposing. to. often it is not always clear and the plait can be imposed without need. The paramedic, and furthermore the doctor is obliged at arrival of the wounded with imposed. to. to resolve an issue of its expediency. In doubtful cases the bandage is removed, a finger press the main artery above. to., then it is dismissed and stop manual pressing. If bleeding renews, the plait is tightened again. If in 2 — 3 min. there is no bleeding, then the plait is not tightened, but leave it wrapped around an extremity provizorno. The compressing bandage at the same time is by all means applied a wound. To evacuate wounded with a provisional plait it is admissible only with the attendant and at such placement in transport that it was possible to tighten immediately a plait at emergence of symptoms of bleeding. Imposing. to. in the battlefield quite often was the only recovery aid of life the wounded, and also the victim in peace time of the injuries which are followed by severe bleeding.

However use of a plait can become the reason of a number of serious complications. The most dangerous of them so-called turnstile shock — one of kinds of a syndrome of revascularization is considered. It can develop after relaxation of the plait which is previously tightened within several hours. Excessively tightened plait causes crush of muscles and injury of nerves therefore persistent paresis, paralyzes and an atrophy of muscles can develop. It is long the extremity drawn by a plait quite often it nekrotizirutsya. At persons at whom long time the plait was tightened wounds heal slowly and often suppurate. Soon after an applying a tourniquet there are pains, sometimes so intensive that wounded try to remove a plait.

The mechanism of action of a plait on an extremity and an organism in general is regarded variously. A number of surgeons attaches paramount significance to reflex influence of mechanical irritation of fabrics a plait. P. A. Kupriyanov, B. A. Petrov considered leaders a factor though temporary, but complete cessation of blood circulation in extremities, accumulations in it toxic products of anaerobic exchange and the subsequent toxaemia of an organism at receipt them in a blood stream after removal of a plait. B. V. Petrovsky with soavt, special significance is attached to redistribution of volume of the blood circulating in an organism during the resuming of a blood-groove in the extremity deprived of blood supply. The specified factors matter in a pathogeny of the complications caused by influence of a plait. However the specific weight of each of them can be various. Apply administration of anesthetics and novocainic blockade to prevention of turnstile shock proksimalny a plait to remove an afferent impulsation, and also artificial cooling of an extremity before removal of a plait. However reliable methods of the prevention of turnstile shock, except early release of extremities from. to., no. Treatment of the developed toxaemia nonspecific is also carried out by the general rules.

Indications to imposing. to. arterial bleedings, and also bleedings which do not stop after imposing of a bandage are.

Contraindication for an applying a tourniquet in hospital conditions for the purpose of temporary switching off of an extremity from blood circulation for medical manipulations suppurative processes on site or near imposing are. to., sharply expressed angiosclerosis.

See also Bleeding .

Bibliography: Banaytis S. I. Bleedings and their stop in field conditions, M., 1952; Golden eagles A. N., Dolinin V. A. and Kornilov V. A. To the 100 anniversary of use of a styptic plait, Surgery, No. 5, page 3, 1973, bibliogr.; Dyadichkin V. P. Medical care at injuries, Minsk, 1973; Kupriyanov P. A. Amputation of extremities (excepting fingers) at stages of sanitary evacuation, L., 1943; Lytkin M. I. and Kolomna V. P's c. Acute injury of the main blood vessels, L., 1973, bibliogr.; Petrov B. A. About a plait, in book: Voyen. medical in Great Otechestv, war, century 3, page 15, M., 1946; Petrovsky B. V. Surgical treatment of wounds of vessels, M., 1949.

K. M. Lisitsyn.