BACKGROUND: The tourniquet has undergone significant advancement since its inception. We outline the evolution of the tourniquet in limb surgery and discuss the continuing importance of historic context. METHOD: A literature search was completed using Medline and Web of Science. RESULTS: The first recorded attempt at managing an arterial bleed was by Sushruta in 600 BC. Similar approaches were applied in ancient Rome using leather or bronze rings. Little progress was made over the next 1,500 years until Ambroise Paré, a French surgeon in the 16th century who used a ligature to control haemorrhage during a leg amputation. In 1674, Morell introduced the field garrotte, composed of a cord tightened by twisting a wooden rod. In 1718, Jean-Louis Petit displayed a pinned tourniquet that applied pressure directly over an artery. In 1864, Lister was likely the first surgeon to use a tourniquet in surgeries other than amputations. Johann Friedrich August von Esmarch introduced the use of a flat rubber bandage to exsanguinate a limb prior to applying a tourniquet in 1873. Harvey Cushing invented the pneumatic tourniquet in 1904, and this was further modified by Kirschner. In 1984, James McEwen invented the automatic tourniquet for surgery. This device automatically measured and applied the minimum pressure required to occlude arterial blood flow in a limb. CONCLUSION: The tourniquet has evolved to become indispensable in operations of the limbs, while continuing to provide life-saving control of bleeding in the emergency setting.