Abstract: The tourniquet, a cornerstone of modern surgical practice, has a history deeply rooted in the evolution of medicine. From its rudimentary origins in antiquity—simple leather bands used to control haemorrhage during amputations—to today’s advanced digital tourniquets employed in vascular and orthopaedic surgery, its development reflects centuries of innovation. Key milestones include the 17th-century introduction of Jean-Louis Petit’s mechanical screw tourniquet, revolutionizing haemostasis. The 19th and 20th centuries saw transformative advancements driven by military medicine, such as pneumatic tourniquets, which provided consistent pressure and minimized tissue damage. Modern devices further refined safety through dynamic blood pressure monitoring and adaptive pressure adjustments, reducing complication rates such as ischemia-reperfusion injury and nerve damage. However, a shift in practice is emerging. Wide-awake local anaesthesia no-tourniquet (WALANT) techniques are becoming the standard in hand surgery, challenging traditional tourniquet use and reshaping the landscape of surgical care. This presentation will explore the historical trajectory of the vascular tourniquet, examining its evolution through historical records, surgical literature, and biomedical advancements. It will also highlight contemporary practices and emerging trends, providing insights into its evolving role in modern surgery. By tracing the history of the tourniquet, we honour its contributions to surgical outcomes and emphasize the ongoing importance of innovation in improving patient care.