Prolonged Field Care Podcast PFC Podcast 252: Prolonged Tourniquet Conversion
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Oct 27, 2025 
Dr. John Holcomb, a trauma surgeon and expert in combat casualty care, joins the discussion to delve into prolonged tourniquet use and its complications. They explore ischemia-reperfusion injury, emphasizing the significance of assessing limb viability through the four C's: color, consistency, contractility, and capillary refill. Holcomb highlights the risks of compartment syndrome and the critical role of training medics in tourniquet conversion to prevent amputations, while also discussing varying battlefield conditions and the need for continuous reassessment in trauma scenarios.
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High Rate Of Unnecessary Tourniquets
- Many tourniquets applied in Ukraine were unnecessary in hindsight, sometimes 50–75% of cases.
- This prompted studying the subset where prolonged tourniquets risk ischemia–reperfusion rather than obvious dead limbs or trivial wounds.
Target The 'Middle Group' For Decisions
- Focus decisions on the middle group: stabilized patients where limb salvage is being attempted.
- Exclude obviously unsalvageable or minimally injured cases to study relevant management strategies.
Use The Four C's For Fast Viability Checks
- Use the four C's—color, consistency, contractility, capillary refill—to assess muscle viability quickly.
- Make small incisions in undamaged muscle and test contractility with forceps, not electrocautery or bovie.