A safe and physiologic method for a less bloody surgical field in diabetic foot surgery: elevation with the trapezoid pillow.

Bleeding from the site of surgery generally leads to obscurity of the surgical field, which may complicate the execution of the procedure. It also increases the duration of the operation and may necessitate blood transfusion. Although bleeding from large and medium size vessels can be controlled by using electrocoagulation and ligation of the vessel, capillary oozing and bleeding from the small size vessels can persist. Any attempt to stop this type of bleeding with electrocoagulation may damage tissues and cause wound healing problems. The use of esmarch bandages or tourniquets in upper and lower extremity surgery allows surgeons to work in a bloodless surgical field. For years this modality has been used to provide comfortable and successful operation in extremity surgery. Conversely, there are some reports regarding serious complications due to the tourniquet or esmarch bandage use such as nerve palsy (1), edema in extremity (2, 3), vascular damage (4), degloving injuries to fragile skin in elderly patients (5), and massive pulmonary embolism (5– 8). Many of these reported complications were seen in patients having no co-morbidities. Operation on diabetic foot requires delicate surgical techniques to minimize surgical trauma that is crucial for successful outcomes. Because the use of esmarch bandages or tourniquets may cause severe complications even in healthy people, we developed an alternative method to minimize bleeding in surgery of the diabetic foot. A trapezoid pillow was designed not only to decrease bleeding but also to improve access and exposure in diabetic foot surgery, and is presented herein.