MIDTHIGH AMPUTATIONS FOR ARTERIOSCLEROTIC AND DIABETIC GANGRENE

Abstract

MIDTHIGH amputations for gangrene resulting from peripheral vascular disease, arteriosclerotic and/or diabetic, have presented a number of important problems which have a direct relationship to morbidity and mortality. They include procrastination and timing of operation; technical methods; closed versus open stumps; anesthesia, especially the contraindicated refrigeration anesthesia with tourniquet; postoperative stump care, and supportive and nutritional therapy. During World War II, the Surgeon General's Office deemed it advisable to adopt a standard method for midthigh amputations, leaving the stumps open and applying traction. This was sound practice in comparatively young men, whose wounds almost always had virulent mixed infections and frequent long latent periods before operative therapy. It was also possible that this procedure was safer in the hands of those with limited experience. Medical officers became so thoroughly indoctrinated with the principle of traction on stumps which were left open that some of them have permitted this method to