MANAGEMENT of the critically ill patient with moist gangrene of an extremity has always been a difficult problem. Treatment by the standard types of amputation with closure of the stump was abandoned years ago because the mortality was so high—often close to 100 per cent. Guillotine amputation with the stump left wide open was found to be much safer, the idea being to get rid of the gangrenous part as rapidly and simply as possible and to reamputate at a higher level when the patient's condition improved enough to warrant the procedure. But even with the protection afforded by the sulfonamide compounds and penicillin, such staged procedures have left much to be desired. Since the operative mortality has remained alarmingly high, investigations leading toward other more satisfactory methods of management of this critically ill group of patients have continued.
With the introduction of refrigeration anesthesia by Allen and Crossman,1
LARGE A. PHYSIOLOGIC AMPUTATION BY TOURNIQUET AND REFRIGERATIONTreatment of the Infected Gangrenous Extremity. Arch Surg. 1950;60(4):683-690. doi:10.1001/archsurg.1950.01250010704004