2.1 Tourniquet Application

Appropriate placement of a tourniquet is essential and is usually performed before skin preparation, unless a sterile tourniquet is being used. Two loops of wool or similar should be wrapped around the arm before tourniquet application. More than two loops may result in a loss of pressure applied to the arm (Fig. 2‑1, Fig. 2‑2). Furthermore, adhesive tape should be placed around the tourniquet (Fig. 2‑3). This prevents any prep solution leaking under the tourniquet which would risk causing a chemical burn. Tourniquet burns are indefensible.

2.2 Theater Draping and Lighting

The hand is prepared with an antiseptic solution. If the arm is paralyzed or the patient is under general anesthetic, an unscrubbed member of the theater team holds the arm up to facilitate the skin preparation (Fig. 2‑4).

In some instances, if the hand is contaminated and embedded with particulate matter, a prescrub is necessary with a disposable nailbrush. The hand is then passed through an aperture drape and the primary surgeon should sit on the ulnar side of the hand (Fig. 2‑5, Fig. 2‑6). Two theater lights should be positioned in the direction of the patient’s hand with the surgeon sitting in between the two lights (Fig. 2‑7).