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November 1964

Treatment of "Toxemia" After Extremity Replantation

Author Affiliations

Clinical Instructor in Surgery (Dr. Mehl, Dr. Paul), Clinical Assistant Professor of Surgery (Dr. Shorey), Associate Professor of Surgery (Dr. Schneewind), and Professor of Surgery (Dr. Beattie), University of Illinois, School of Medicine.; From the Department of Surgery, Presbyterian-St. Luke's Hospital.

Arch Surg. 1964;89(5):871-879. doi:10.1001/archsurg.1964.01320050117010

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

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