Controversy has surrounded the role of local
hypothermia as a preoperative treatment in
amputations of the lower extremity. A study was undertaken to determine the effectiveness of
amputation under
cryoanesthesia in decreasing postoperative morbidity and mortality in below-knee (BK)
amputations. Of 154 BK
amputations, only 91 with unreconstructable
vascular disease,
gangrene, or both, were included in this study. Group I consisted of 48 patients (mean age 63.9 years) who had undergone a routine BK
amputation; group II consisted of 43 patients (mean age 65.7 years) who were acutely ill and too unstable to undergo a major
surgical procedure. Group II patients were treated by
amputation while under
cryoanesthesia before any definitive operative intervention. The patients in group II were significantly (p less than 0.05) more ill preoperatively than those in group I. Group II patients had a higher prevalence of previous
myocardial infarction, previous
stroke,
diabetes mellitus,
osteomyelitis, and wet
gangrene. Seventy percent of the patients in group II had three or more risk factors vs. 46% in group I. Early postoperative mortality rates did not differ significantly between groups (group I, 8%; group II, 9%); the average length of
hospital stay for group I patients was 24.2 days compared with 17.7 days in group II. Group II patients sustained slightly more postoperative complications.
Amputation under
cryoanesthesia appears to be of value in reducing postoperative morbidity and mortality and length of
hospital stay in the acutely ill patient with unreconstructable
vascular disease,
gangrene, or both.