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Treatment of Toxemia After Extremity Replantation

Treatment of Toxemia After Extremity Replantation Abstract Replantation of extremities has been followed in a number of cases by profound clinical shock.1,2 Similarly, in World War II, patients with "crush syndrome" were well immediately after the release of the compression but developed shock within hours.3-10 Our study is concerned with various features of this syndrome and describes a possible way to avert a fatal outcome. We attempted to answer the following questions: How many hours of limb ischemia can the dog tolerate? How can survival time be improved and what limits successful treatment? Methods After light sodium pentobarbital anesthesia (30 mg per kilogram) 60 healthy mongrel dogs, averaging 14 kg in weight, were subjected to a simulated amputation. This consisted of a complete transection of the right midthigh except for femoral vessels, femoral and sciatic nerves, and the femur. Through a femoral window, marrow was removed and the cavity packed tightly with bone wax. The References 1. Statham Company, Hato Rey, Puerto Rico. 2. Pharmacia, Uppsala, Sweden. 3. Swenko Manufacturing Company, Minneapolis. 4. Shorey, W. D.; Schneewind, J.; and Mehl, R. L.: Experience With Replanted Hand, read before the International College of Surgeons, Rome, Italy, 1963. 5. Mehl, R. L., et al: Patency of Microcirculation in Traumatically Amputated Limb, J Trauma, to be published. 6. Beall, D., et al: Case of Crush Injury With Renal Failure , Brit Med J 1:432, 1941.Crossref 7. Bywaters, E. G. L., and Beall, D.: Crush Injuries With Impairment of Renal Function , Brit Med J 1:427, 1941.Crossref 8. Glen, A. M.: Temporary Vascular Occlusion Ending Fatally in Uraemia , Brit Med J 2:875, 1941.Crossref 9. Longland, C. J., and Murray, J.: Case of Recovery From Crush Syndrome , Lancet 2:158, 1941.Crossref 10. Medical Research Council Subcommittee of Traumatic Edema: Further Cases of Crush Injury , Brit Med J 1:449, 1941.Crossref 11. Patey, D. H., and Robertson, J. D.: First-Aid Prophylactic Treatment of Compression Syndrome ("Crush Syndrome") , Brit Med J 2:212, 1942.Crossref 12. Patey, D. H., and Robertson, J. D.: Compression Treatment of Crush Injuries of Limbs , Lancet 1:780, 1941.Crossref 13. Robertson, H. R., and Mathews, W. H.: Crush Syndrome , Canad Med Ass J 1:116, 1942. 14. Astrup, P.: Simple Electrometric Technique for Determination of Carbon Dioxide Tension in Blood and Plasma, Total Content of Carbon Dioxide in Plasma, and Bicarbonate Content in "Separated" Plasma, at a Fixed Carbon Dioxide Tension (40 mm Hg) , Scand J Clin Lab Invest 8:33, 1956.Crossref 15. Astrup, P., and Schroder, S.: Apparatus for Anaerobic Determination of pH of Blood at 38 Degrees Centigrade , Scand J Clin Lab Invest 8:30, 1956.Crossref 16. Lapchinsky, A. G.: Recent Results of Experimental Transplantation of Preserved Limbs and Kidneys and Possible Use of Technique in Clinical Practice , Ann NY Acad Sci 64:539, 1960. 17. Wilson, H., and Roome, N. W.: Effects of Constriction and Release of Extremity , Arch Surg 32:334, 1936.Crossref 18. Duncan, G. W., and Blalock, A.: Uniform Production of Experimental Shock by Crush Injury: Possible Relationship to Clinical Crush Syndrome , Ann Surg 115:684, 1942.Crossref 19. Darby, T. D.: Effects of 2-Amino-2-Hydroxymethyl-1,3-Propanediol During Shock and Catecholamine Administration , Ann NY Acad Sci 92:674, 1961.Crossref 20. Crowell, J. W.; Bounds, S. H.; and Johnson, W. W.: Effect of Varying Hematocrit Ratio on Susceptibility to Hemorrhagic Shock , Amer J Physiol 192:171, 1958. 21. Lillehei, R.: Student American Medical Association Symposium on Shock , Chicago, May, 1964. 22. Longerbeam, J. K., et al: Treatment of Irreversible Shock, exhibit at the 49th Clinical Congress of the American College of Surgeons, San Francisco, Oct 28-Nov 1, 1963. 23. Selmonosky, C. A.; Goetz, R. H.; and State, D.: Role of Acidosis in Irreversibility of Experimental Hemorrhagic Shock , J Surg Res 3:491, 1963.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Treatment of Toxemia After Extremity Replantation

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References (20)

Publisher
American Medical Association
Copyright
Copyright © 1964 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1964.01320050117010
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Abstract

Abstract Replantation of extremities has been followed in a number of cases by profound clinical shock.1,2 Similarly, in World War II, patients with "crush syndrome" were well immediately after the release of the compression but developed shock within hours.3-10 Our study is concerned with various features of this syndrome and describes a possible way to avert a fatal outcome. We attempted to answer the following questions: How many hours of limb ischemia can the dog tolerate? How can survival time be improved and what limits successful treatment? Methods After light sodium pentobarbital anesthesia (30 mg per kilogram) 60 healthy mongrel dogs, averaging 14 kg in weight, were subjected to a simulated amputation. This consisted of a complete transection of the right midthigh except for femoral vessels, femoral and sciatic nerves, and the femur. Through a femoral window, marrow was removed and the cavity packed tightly with bone wax. The References 1. Statham Company, Hato Rey, Puerto Rico. 2. Pharmacia, Uppsala, Sweden. 3. Swenko Manufacturing Company, Minneapolis. 4. Shorey, W. D.; Schneewind, J.; and Mehl, R. L.: Experience With Replanted Hand, read before the International College of Surgeons, Rome, Italy, 1963. 5. Mehl, R. L., et al: Patency of Microcirculation in Traumatically Amputated Limb, J Trauma, to be published. 6. Beall, D., et al: Case of Crush Injury With Renal Failure , Brit Med J 1:432, 1941.Crossref 7. Bywaters, E. G. L., and Beall, D.: Crush Injuries With Impairment of Renal Function , Brit Med J 1:427, 1941.Crossref 8. Glen, A. M.: Temporary Vascular Occlusion Ending Fatally in Uraemia , Brit Med J 2:875, 1941.Crossref 9. Longland, C. J., and Murray, J.: Case of Recovery From Crush Syndrome , Lancet 2:158, 1941.Crossref 10. Medical Research Council Subcommittee of Traumatic Edema: Further Cases of Crush Injury , Brit Med J 1:449, 1941.Crossref 11. Patey, D. H., and Robertson, J. D.: First-Aid Prophylactic Treatment of Compression Syndrome ("Crush Syndrome") , Brit Med J 2:212, 1942.Crossref 12. Patey, D. H., and Robertson, J. D.: Compression Treatment of Crush Injuries of Limbs , Lancet 1:780, 1941.Crossref 13. Robertson, H. R., and Mathews, W. H.: Crush Syndrome , Canad Med Ass J 1:116, 1942. 14. Astrup, P.: Simple Electrometric Technique for Determination of Carbon Dioxide Tension in Blood and Plasma, Total Content of Carbon Dioxide in Plasma, and Bicarbonate Content in "Separated" Plasma, at a Fixed Carbon Dioxide Tension (40 mm Hg) , Scand J Clin Lab Invest 8:33, 1956.Crossref 15. Astrup, P., and Schroder, S.: Apparatus for Anaerobic Determination of pH of Blood at 38 Degrees Centigrade , Scand J Clin Lab Invest 8:30, 1956.Crossref 16. Lapchinsky, A. G.: Recent Results of Experimental Transplantation of Preserved Limbs and Kidneys and Possible Use of Technique in Clinical Practice , Ann NY Acad Sci 64:539, 1960. 17. Wilson, H., and Roome, N. W.: Effects of Constriction and Release of Extremity , Arch Surg 32:334, 1936.Crossref 18. Duncan, G. W., and Blalock, A.: Uniform Production of Experimental Shock by Crush Injury: Possible Relationship to Clinical Crush Syndrome , Ann Surg 115:684, 1942.Crossref 19. Darby, T. D.: Effects of 2-Amino-2-Hydroxymethyl-1,3-Propanediol During Shock and Catecholamine Administration , Ann NY Acad Sci 92:674, 1961.Crossref 20. Crowell, J. W.; Bounds, S. H.; and Johnson, W. W.: Effect of Varying Hematocrit Ratio on Susceptibility to Hemorrhagic Shock , Amer J Physiol 192:171, 1958. 21. Lillehei, R.: Student American Medical Association Symposium on Shock , Chicago, May, 1964. 22. Longerbeam, J. K., et al: Treatment of Irreversible Shock, exhibit at the 49th Clinical Congress of the American College of Surgeons, San Francisco, Oct 28-Nov 1, 1963. 23. Selmonosky, C. A.; Goetz, R. H.; and State, D.: Role of Acidosis in Irreversibility of Experimental Hemorrhagic Shock , J Surg Res 3:491, 1963.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Nov 1, 1964

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