J Bone Joint Surg Br. 1980 Aug; 62(3):385-8. KlenermanL, BiswasM, HulandsGH, Rhodes AM.
The effect of the application of a tourniquet to a limb and the release of the accumulated metabolites have been investigated with reference to the acid-base level in the blood from the limb and in the right atrium.
Investigations have been carried out experimentally in rhesus monkeys and observations have been made on patients undergoing reconstructive operations on the knee. The acidotic blood from the ischemic limb produces a little systemic effect. The limb recovers in approximately 40 minutes after a tourniquet has been in place for four hours. Three hours is recommended as a reasonable upper limit for the safe application of a pneumatic tourniquet.
The Effect of Pneumatic Tourniquets on the Ultrastructure of Skeletal Muscle
J Bone Joint Surg Br. 1979 May;61-B(2):178-83. Patterson S, KlenermanL
Experiments have been carried out on rhesus monkeys to determine the effect of the application of a pneumatic tourniquet on the ultrastructure of the muscles of the lower limb. Tourniquets were applied for periods lasting between one and five hours. The changes in the muscle lying immediately under the cuff of the tourniquet were more marked than those observed in muscle distal to the cuff. Three hours appear to be close to the limit of the time that a muscle can resist the sustained compression of a tourniquet