Twisting Tourniquet Technique
Twisting Tourniquet (Schnogh inThai) maneuver, a protocol for compression-decompression therapy. The Twisting Tourniquet Technique (TTT) is best practiced in a combination of twist and untwist alternately to generate a compression and decompression effect on the swollen limb. Having tested in preliminary study, we found that 80–90 mmHg is optimum for a 15-min twist followed by a 5-min untwist, that is, three consecutive sessions in 1 h. Treatment of 10 sessions, ∼3½ h a day, is normally acceptable by most individuals. This regimen is the core therapy in reduction phase, which was performed intensively during the ambulatory admission program (one 5-day course, or more); after discharge each patient would be assigned individually with a home program in maintenance phase, relying on physician-prescribed compression materials which can be revised at next follow-up.
In actual regimen, a limb is prepared as illustrated in Figures. Conforming bandages were used to wrap fingers or toes, with tips opened, hand or foot, and the entire limb length. A second layer was covered by elastic bandages, and a third layer by a neoprene wrap. The fourth layer was for mounting the Schnogh. At the dorsum of hand or foot, instead of Schnogh we applied a One-Touch Free Supporter (Daiya, Okayama, Japan), which is a free-wrapping elastic material with Velcro closure. Schnogh pressure at the distal segment was twisted to 80–90 mmHg, and was slightly lessened 3–5 mmHg for each segment to generate a descending gradient distoproximally. Calibration was done by a body-surface pressure gauge (Cape, Tokyo, Japan). In precaution to any adverse reaction that might incur during the procedure, we routinely instruct every patient to not ignore any sign of changes such as pain, numbness, itch, discoloration in finger/toe tips, and any subjective discomfort; such complaints are easily erased by untwisting Schnogh, readjusting position, correcting posture, or unmounting and remounting the Schnogh.