THE THERAPEUTIC VALUE OF REFRIGERATION IN ACUTE TRAUMATIC ARTERIAL DEFICIT

¹ Department of Orthopaedic Surgery, Rothschild-Hadassah University Hospital, Jerusalem, Israel

1. Limb refrigeration for periods ranging from five to twenty-four days was used in twenty cases of traumatic extremity vascular deficit.

2. The greatest value of limb refrigeration was found in cases of multiple injuries, when the patient's general condition was unsatisfactory. It allowed other emergency operative procedures to be undertaken while the limb was placed in cold storage until an elective and safe amputation could be performed. This form of therapy has a field of application in war surgery.

3. No unusual development of collateral channels or "preservation of tissue" was noticed. The level of the line of demarcation coincided with that normally to be anticipated without refrigeration.

4. Refrigeration prevented the development of moist gangrene and produced a comparatively safe dry gangrene. The whole tempo of change in the affected limb was markedly slowed. The appearance of the line of demarcation was delayed until the twelfth to sixteenth day.

5. Four cases of gas gangrene occurred. At low temperatures, oxyhemoglobin does not dissociate and a relatively anaerobic field is produced. Proximal contamination and temperature fluctuation thus account for this high incidence.

6. Withdrawal of refrigeration before the development of dry gangrene caused a rapid deterioration of the limb and a fulminating toxaemia.

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