Cryoamputation as a Lifesaving Intervention: A Case Report, Description of Technique, and Review of the Literature.

Abstract

Emergency amputation of ischemic or infected limbs in critically ill patients is associated with substantial morbidity and mortality. Cryoamputation involves a physiologic amputation, effectively isolating the offending limb without actual amputation, as a lifesaving, temporizing measure in the subset of patients who cannot undergo a surgical amputation1,2. A physiologic amputation should be considered in disaster scenarios or with those patients who are experiencing systemic toxicity from the offending limb but whose current condition or extraneous circumstances do not permit a surgical amputation. Cryoamputation involves the application of an occlusive tourniquet to isolate the affected extremity, with subsequent cooling with use of dry ice (frozen carbon dioxide), common ice, or special cooling systems. This allows for patients to be medically optimized prior to undergoing a formal amputation. This approach may be valuable even in situations when long-term survival is not anticipated. The benefit of this technique is that it allows a high-risk emergency amputation to be performed in an elective fashion after medical optimization. We present a case of cryoamputation and review the literature on this subject. We are not aware of any prior report of this technique in the orthopaedic literature. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. The Orthopaedic Surgery Service was emergently consulted by the Vascular Surgery Service to assist with bilateral transfemoral amputation. A fifty-six-year-old man with a history of multiple bypass procedures presented with acute-on-chronic worsening of severe peripheral vascular disease in the setting of a hypercoagulable state. At the time of our initial consultation, the patient had bilateral lower limbs that were cool to the touch and insensate to the level of the proximal part of the thigh. The case was complicated by prior bilateral total hip arthroplasty with prosthesis …