TITLE:
Is the Critical Patient with a Septic Limb Too Sick for an Emergent Amputation? A Case Report Illustrating How to Perform a Bedside Physiologic Amputation
AUTHORS:
Samantha A. Delapena, Luis G. Fernandez, Devin O’Connor, Katharine A. Dishner, Marc R. Matthews
KEYWORDS:
Physiologic Amputation, Cryoamputation, Critically Ill, Sepsis, Septic Shock, Cryoanesthesia Amputation, Medical Amputation
JOURNAL NAME:
Surgical Science,
Vol.13 No.4,
April
28,
2022
ABSTRACT: A physiologic
amputation is an important option for the critically ill patient who has
irreversible limb disease with necrotic wounds but who would have a low
probability of surviving a standard open amputation, without effective
preoperative resuscitation, antibiotics, and correction of metabolic
derangements. An open amputation may be required secondary to vascular ischemic
disease, necrotizing fasciitis, or thermal injury that has led to the critical
and unstable condition. The physiologic amputation stabilizes the patient while
preventing further metabolic deterioration. The cryoamputation is intended to rescue the patient’s life and is not meant for
limb salvage. While physiologic amputation has been described for over a
century, it is uncommonly performed. This case report describes a physiologic
amputation in a step-by-step fashion for the surgeon attempting to save a
critically ill patient’s life who might not otherwise survive an open
amputation.