the embodiment illustrated is not intended to be exhaustive or limit the invention to the precise form disclosed . it is chosen and described in order to explain the principles of the invention and its application and practical use , and thereby enable others skilled in the art to utilize the invention . [ 0023 ] fig1 depicts the preferred embodiment applied to a limb of a surgical patient . limb protection sleeve 2 has been applied by a user to limb 4 along a portion of its length . inflatable tourniquet cuff 6 is applied on top of a proximal portion of limb protection sleeve 2 to encircle the portion of sleeve 2 and limb 4 at a location desired by a user . cuff 6 is pneumatically connected to tourniquet instrument 8 through pneumatic port 10 and pneumatic tubing 12 . prior to the commencement of surgery , the portion of sleeve 2 distal to cuff 6 is folded back on top of cuff 6 by the user , as depicted in fig6 c . tourniquet instrument 8 can then supply gas to tourniquet cuff 6 at a pressure sufficient to stop blood flow in limb 4 past cuff 6 and sleeve 2 for a time period sufficient for the performance of a surgical procedure . [ 0024 ] fig2 depicts the inner surfaces of tourniquet cuff 6 , cuff 14 , cuff 16 and cuff 18 , which are pediatric tourniquet cuffs of different sizes that are distributed by delfi medical innovations inc . ( vancouver , canada ). each of cuffs 6 , 14 , 16 and 18 is constructed of materials and in a manner generally similar to tourniquet cuffs of the prior art such as those described by mcewen in u . s . pat . nos . 5 , 454 , 831 and 5 , 649 , 954 . cuffs 6 , 14 , 16 and 18 shown in fig2 have overall cuff width and cuff length dimensions as given in the table below . also , for each of cuffs 6 , 14 , 16 and 18 , the table shows the maximum limb circumference and the minimum limb circumference recommended by the distributor in the product literature and instructions provided for users . to assist users in easily identifying and differentiating among cuffs , the tie straps of different cuffs have different colors : cuffs 6 , 14 16 and 18 have green , red , blue and black tie straps , respectively , as summarized in the table . cuff no . overall overall recommended recommended from fig2 cuff cuff minimum limb maximum limb ( and color length width circumference circumference of tie straps ) ( inches ) ( inches ) ( inches ) ( inches ) 6 ( green ) 17 . 7 3 . 50 8 . 3 15 . 3 14 ( red ) 14 . 9 3 . 00 6 . 9 12 . 5 16 ( blue ) 10 . 6 2 . 25 4 . 9 8 . 3 18 ( black ) 7 . 5 1 . 50 3 . 5 5 . 6 [ 0026 ] fig3 shows the outer surface of cuff 6 that faces away from limb 4 when cuff 6 encircles limb 4 . the length 24 of cuff 6 is 17 . 7 inches and the width 26 of cuff 6 is 3 . 50 inches . cuff 6 contains an inflatable chamber 28 , the boundary of which can be seen in fig2 . cuff 6 is designed to allow a user to encircle a patient &# 39 ; s limb 4 at a desired location 30 so that a portion of inflatable chamber 28 of cuff 6 overlaps upon itself , and so that the user can secure encircled cuff 6 around limb 4 by fully engaging primary cuff fastener 32 to fastening strip 34 and by fully engaging secondary cuff fastener 36 to fastening strip 34 . complementary hook and loop materials , such as those known in the prior art as velcro ™, are permanently attached in positions shown in fig2 and 3 to form primary cuff fastener 32 , fastening strip 34 and secondary cuff fastener 36 . primary cuff fastener 32 and secondary cuff fastener 36 are formed of hook material , and fastening strip 34 is formed of loop material . the user may also tie together tie straps 20 and 22 as depicted in fig1 to secure cuff end 38 . when secured around limb 4 and inflated with gas from tourniquet instrument 8 at a sufficient pressure , cuff 6 can apply pressure around encircled limb 4 to stop the flow of arterial blood past cuff 6 into limb 4 . cuff 6 is further designed to encircle limb 4 if limb 4 has a limb circumference greater than 8 . 3 inches and less than 15 . 3 inches at location 30 , as specified in product literature and instructions provided by the distributor for the user . as illustrated in fig1 and 3 , when cuff 6 is applied to limb 4 at location 30 having a circumference between the maximum and minimum circumferences recommended to the user , then the following four conditions occur : ( 1 ) a portion of inflatable chamber 28 overlaps upon itself around limb 4 , thereby producing a uniform application of pressure around limb 4 when chamber 28 is inflated , ( 2 ) primary cuff fastener 32 can be fully engaged with fastening strip 34 by the user to secure cuff 6 around limb 4 , ( 3 ) secondary cuff fastener 36 can also be fully engaged with fastening strip 34 by the user to secure cuff 6 around limb 4 independently of primary cuff fastener 32 , and ( 4 ) tie straps 20 and 22 can be tied together by the user to secure cuff end 38 . if the circumference of limb 4 at location 30 is greater than the maximum circumference of 15 . 3 inches recommended to the user , then cuff 6 may not safely stop blood flow because of the occurrence of one or more of the following three conditions : ( 1 ) primary cuff fastener 32 may not filly engage with fastening strip 34 ; ( 2 ) inflatable chamber 28 may not overlap upon itself around limb 4 , thereby producing a non - uniform application of pressure around the limb when inflated ; and ( 3 ) tie straps 20 and 22 may be obstructed by pneumatic port 10 of cuff 6 , thereby preventing straps 20 and 22 from being tied together to secure cuff end 38 . alternatively , if the circumference of limb 4 at location 30 is less that the minimum circumference of 8 . 3 inches , then the efficacy and safety of cuff 6 may be impaired by the occurrence of one or more of the following four conditions : ( 1 ) the width of cuff 6 may be excessive relative to the length of limb 4 , resulting in hazardous application of pressure by cuff 6 to nerves and soft tissues near the knee or elbow joints of lower or upper limbs respectively ; ( 2 ) the width of cuff 6 may be excessive relative to the length of limb 4 , increasing the obstruction of potential surgical sites distal to cuff 6 ; ( 3 ) secondary cuff fastener 36 may not filly engage with fastening strip 34 ; ( 4 ) tie straps 20 and 22 may be obstructed by pneumatic port 10 of cuff 6 , thereby preventing straps 20 and 22 from being tied together to secure cuff end 38 . limb protection sleeve 2 of the preferred embodiment is designed for use with tourniquet cuff 6 by designing sleeve 2 to have the following four physical properties . first , sleeve 2 has a tubular and elastically stretchable shape , with an unstretched circumference of less than the minimum limb circumference recommended for cuff 6 so that it is elastically stretched when applied to a limb having the minimum recommended circumference and applies a minimum pressure of 2 mmhg , the low pressure threshold that the inventor has discovered in experiments is effective in reducing wrinkling and pinching . the level of 2 mmhg was determined in these tests to be the minimum pressure at which wrinkling and pinching of the tissue beneath cuff 6 began to be visibly reduced . the second physical property of sleeve 2 is that it can be elastically stretched in a radial direction to a circumference at least equal to the maximum limb circumference recommended for cuff 6 . the third property of sleeve 2 is that , when elastically stretched and applied to a limb having the maximum recommended circumference , the maximum pressure applied to the underlying limb by sleeve 2 is less a predetermined maximum pressure threshold of 25 mmhg , determined by the inventor in experiments to be the maximum pressure normally resulting from the snug application of cuff 6 alone to the limb . the fourth physical property of sleeve 2 is that , when applied to a limb having the maximum recommended circumference , the length of sleeve 2 is greater than the width of cuff 6 , so that a portion of sleeve 2 can be folded over cuff 6 prior to the commencement of surgery , as shown in fig6 c . [ 0031 ] fig4 a , 4 b and 4 c show how limb protection sleeve 2 is designed and made to match cuff 6 by having the physical properties described above . first , tubular stockinette 40 shown in fig4 a is produced by knitting type 18 / 1 ring spun cotton yarn fiber of natural color using 160 needles and 25 courses per inch . this results in tubular stockinette 40 having a circumference of 7 . 0 inches ( twice a “ layflat ” width of about 3 . 5 inches ) when not stretched in a radial direction , and having a maximum circumference of 26 inches ( twice a “ cross stretch ” width of 13 inches ) when stretched radially to the maximum . stockinette 40 is cut to a length of 22 . 0 inches and folded back onto itself as shown in fig4 b , producing a tube having two layers and a length of 11 . 0 inches when unstretched . as depicted in fig4 c , the unfolded end is bias cut . this is done with the stockinette laid flat , to remove a piece having length 42 equal to 2 . 5 inches and width 44 equal to half of the layflat width of the stockinette , as shown in fig4 c . the unfolded end that includes the bias cut is then serge - sewn with green thread to produce limb protection sleeve 2 having a green edge 46 . as indicated in fig1 the bias cut of sleeve 2 allows sleeve 2 to be positioned as proximally as possible on limb 4 while still protecting a portion of limb 4 from port 10 and tubing 12 . sewn edge 46 increases the stability of dual - layer sleeve 2 under matching cuff 6 when cuff 6 is inflated and pressurized to stop blood flow , and the knit shape of sleeve 2 is compressible in response to the application of the pressure by matching cuff 6 . in certain applications ( such as adult limbs with less restricted areas of surgical access ), port 10 and tubing 12 may be located on the cuff midline near location 30 ( see fig1 ) rather than in a proximally protruding port portion of the cuff . in this case , the proximally protruding portion of the sleeve formed by the bias cut of dimensions 42 and 44 ( shown in fig4 c ) is not required and the sleeve may be positioned on the limb with the serge - sewn edge lying proximal or distal to the cuff . in either orientation the portion of the sleeve extending distally from the cuff may be folded over the cuff as shown in fig6 c . such sleeves are explicitly matched to the corresponding cuff by designing the sleeves to have the physical properties described above . to confirm that the design of sleeve 2 of the preferred embodiment , as described above , produces the necessary physical properties , sleeve 2 is applied to cover a simulated limb having a circumference equal to 15 . 3 inches , the maximum circumference recommended for matching cuff 6 . a biomedical pressure transducer similar to that described by mcewen in u . s . pat . no . 4 , 869 , 265 is inserted between sleeve 2 and the simulated limb to measure the applied pressure . the maximum pressure applied by sleeve 2 , as measured by the transducer in these design validation tests , is less than 15 mmhg , a pressure known from previous testing done by the inventor to be substantially less than the maximum non - pneumatic pressure of approximately 25 mmhg that typically can be produced by a tourniquet cuff when snugly applied to a limb by a user . also , sleeve 2 is applied to cover a simulated limb having a circumference equal to 8 . 3 inches , the minimum circumference recommended for matching cuff 6 , to confirm that sleeve 2 is elastically stretched after application , thus minimizing any residual wrinkling and irregularities , and to confirm using the same pressure transducer that the pressure applied to the simulated limb of minimum circumference by the elastically stretched sleeve is greater than the predetermined pressure threshold shown to begin to reduce visible wrinkling and pinching , and that the pressure is substantially less than 25 mmhg , the predetermined maximum pressure threshold . it has been demonstrated in testing ( for example , see tredwell s j , wilmink m , inkpen k , and mcewen j : “ pediatric tourniquets : analysis of cuff / limb interface , current practice , and guideline for use ” journal of pediatric orthopaedics 2001 , in press ; and mcewen j a , bailey k , inkpen k , “ tourniquet safety : what type of padding should be used under the cuff to help prevent skin injuries ?”, in review for publication in aorn journal ) that a stretched sleeve such as sleeve 2 of the present invention applies a pressure greater than a predetermined minimum pressure threshold at the minimum recommended limb circumference such that that wrinkling and pinching is visibly reduced , and less than a maximum pressure threshold at the maximum recommended limb circumference , and that the application of such a pressure substantially reduces wrinkling and pinching of the soft tissues beneath tourniquet cuffs such as cuff 6 , as compared to other prior art cuffs applied over loose sleeves , over loose padding , or applied directly on the bare limb . the color of green edge 46 allows a user to visually match sleeve 2 to tourniquet cuff 6 having green tie straps 20 and 22 . although a common color is used in the preferred embodiment to associate sleeve 2 and cuff 6 , it will be appreciated by those skilled in the art that alternate means might be used , such as marking numbers , letters or symbols directly on sleeve 2 and cuff 6 or on packages containing each . if cuff 6 and sleeve 2 are both designed as disposable medical devices , intended for use in only one surgical procedure and disposal after the procedure without re - use on another patient , then an alternate way of matching sleeve 2 and cuff 6 for the user is to package them together at time of manufacture , for example by putting them in the same bag or box . [ 0033 ] fig5 shows four sizes of limb protection sleeves 2 , 48 , 50 and 52 that are matched to tourniquet cuffs 6 , 14 , 16 and 18 respectively . sleeves 48 , 50 and 52 are designed , manufactured and validated as described above for sleeve 2 , except that each has a different length , unstretched circumference , circumference at maximum stretch , and edge color . sleeve 48 matches cuff 14 and is produced by : ( a ) knitting the same type of cotton fiber using 124 needles and 23 courses per inch , resulting in tubular stockinette having a circumference of 5 . 0 inches when not stretched in a radial direction , and having a maximum circumference of 18 . 0 inches when stretched radially to the maximum ; ( b ) cutting the stockinette and folding it back onto itself to create a tube having two layers and a length of 9 . 5 inches , and ( c ) bias cutting an unfolded edge and serging the cut edge with red thread to produce red edge 54 matching the red tie straps of cuff 14 . sleeve 50 matches cuff 16 and is produced by : ( a ) knitting the same type of fiber using 70 needles and 22 courses per inch , resulting in tubular stockinette having a circumference of 3 . 0 inches when not stretched in a radial direction , and having a maximum circumference of 13 . 0 inches when stretched radially to the maximum ; ( b ) cutting the stockinette and folding it back onto itself to create a tube having two layers and a length of 8 . 0 inches , and ( c ) bias cutting the unfolded edge and serging the cut edge with blue thread to produce blue edge 56 matching the blue tie straps of cuff 6 . sleeve 52 matches cuff 18 and is produced by ( a ) knitting the cotton yarn fiber using 40 needles and 21 courses per inch , resulting in tubular stockinette having a circumference of 1 . 5 inches when not stretched in a radial direction , and having a maximum circumference of 7 . 0 inches when stretched radially to the maximum ; ( b ) cutting the tubular stockinette and folding it back onto itself to create a tube having two layers and a length of 7 . 0 inches , and ( c ) bias cutting the unfolded edge and serging the cut edge with black thread to produce black edge 58 matching the black tie straps of cuff 18 . for each of limb protection sleeves 2 , 48 , 50 and 52 shown in fig5 the table below summarizes the respective sleeve length , sleeve edge color , unstretched sleeve circumference , maximally stretched sleeve circumference , matching cuff , and the recommended minimum and maximum limb circumferences for sleeve and matching cuff . limb protection sleeve ( in fig5 ): 2 48 50 52 sleeve length ( inches ) 11 . 0 9 . 5 8 . 0 7 . 0 sleeve edge color green red blue black sleeve circumference : unstretched ( in ): 7 . 0 5 . 0 3 . 0 1 . 5 max . stretch ( in ): 26 . 0 18 . 0 13 . 0 7 . 0 matching cuff ( fig2 ) 2 14 16 18 color of tie straps green red blue black recommended limb circumferences for cuff and sleeve : minimum ( inches ): 8 . 3 6 . 9 4 . 9 3 . 5 maximum ( inches ): 15 . 3 12 . 5 8 . 3 5 . 6 [ 0035 ] fig6 a , 6 b and 6 c illustrate steps in a typical selection and application of a tourniquet cuff and matching limb protection sleeve to limb 4 by a user . prior to these steps , the user first observes the location 30 on limb 4 where it is desired to apply a tourniquet cuff and sleeve . the user then selects from the available sizes of cuffs the widest cuff that can : ( a ) fully encircle limb 4 at location 30 with a portion of the cuff overlapping upon itself , ( b ) allow the primary and secondary cuff fasteners to be fully engaged by the user , and ( c ) leave a safe distance between the distal edge of the selected cuff and joint 60 of limb 4 that is immediately distal location 30 . the operating surgeon is responsible for determining this safe distance for each patient , to prevent injury to exposed nerves , vessels and soft tissue near joint 60 . after the cuff is selected , the matching limb protection sleeve is selected ; in the preferred embodiment , this is done by matching the color of the tie straps of the cuff to the color of the sewn edge of the sleeve . fig6 a , 6 b and 6 c indicate that cuff 6 and matching sleeve 2 have been selected for application at desired location 30 on limb 4 . the user slides selected sleeve 2 onto limb 4 over location 30 as illustrated in fig6 a , and after application assures that sleeve 2 is free of wrinkles and that the colored edge 46 of sleeve 2 is positioned as shown in fig6 a to help protect limb 4 from port 10 and tubing 12 . as shown in fig6 b , after application of sleeve 2 , selected cuff 6 is wrapped snugly around the proximal portion of sleeve 2 and limb 4 at the desired location , while assuring that port 10 is positioned over sleeve 2 as shown . after snug application of cuff 6 by the user , the portion of sleeve 2 distal to cuff 6 is folded back over cuff 6 as shown in fig6 c . the operating surgeon then observes cuff 6 and sleeve 2 as applied , to assure that there is still a safe distance between joint 60 and applied cuff 6 and sleeve 2 . the user can then connect tubing 12 to port 10 and inflate cuff 6 using tourniquet instrument 8 to stop blood flow for the performance of a surgical procedure . immediately upon deflation of cuff 6 , both cuff 6 and sleeve 2 are immediately removed from limb 4 to remove any residual restriction of blood flow . it is to be understood that the invention is not to be limited to the details herein given but may be modified within the scope of the appended claims .
apparatus is provided for protecting a patient &# 39 ; s limb from tourniquet - related injury , comprising : a tourniquet cuff having a length sufficient for encircling a limb protection sleeve applied to a limb at a location having a limb circumference of not less than a predetermined minimum limb circumference and not more than a predetermined maximum limb circumference ; limb protection sleeve adapted for applying to the limb at the location , wherein the sleeve has a tubular shape and a tubular circumference predetermined to be less than the predetermined minimum and wherein the sleeve is formed to allow elastic stretching of the tubular shape sufficient to increase the tubular circumference to be substantially equivalent to the limb circumference at the location when the sleeve is applied to the limb , thereby applying a pressure to the limb that is greater than a predetermined minimum pressure and less than a predetermined maximum pressure ; and identification means perceptible to a user for providing an indication to the user of the predetermined minimum limb circumference and the predetermined maximum limb circumference .