Experience with physiologic amputation using the CryoCare Extremity Stabilization System (CESS)

Five years of experience gained with the CryoCare Extremity Stabilization System (CESS) were evaluated in this study. Twenty-one patients underwent freezing amputation. Five patients died before undergoing surgical amputation. Symptomatic relief, control of odor, decreased demand on nursing staff, and appreciation of the family make this approach valuable even when long-term survival is not anticipated. Ten patients who underwent freezing amputation subsequently underwent surgical amputation and were discharged. Six patients underwent freezing and surgical amputation but died prior to discharge. The patients selected for the freezer application were deemed to be prohibitive operative risks because they were experiencing systemic toxicity from their ischemic limb and underlying diseases. Six patients demonstrated myoglobinuria prior to freezing which cleared with CESS. The physiologic amputation allowed stabilization of medical problems including cardiac arrhythmias, congestive heart failure, sepsis, renal failure, diabetes, and respiratory failure. Freezing of an ischemic extremity allows delay in amputation enabling physicians to achieve maximal medical stabilization. It permits symptomatic relief in patients whose long-term survival is not anticipated. Physiologic freezing amputation should be included in the repertoire of all surgeons.