Dry ice freezing as a prelude to surgical amputation

Emergency amputation in the critically ill is associated with 17 to 25% mortality, and a high rate of postoperative infection. Mortality arid morbidity can be reduced by freezing the diseased tissues with dry ice, and deferring surgery until the patient is rendered stable, and metabolically able to heal. Methods of freezing previously reported are cumbersome to maintain, and prone to complications. This paper presents a safe and simple method of physiologic amputation, with emphasis on those details useful to the institution or practitioner who will only occasionally use it. Three illustrative cases demonstrate the utility of this form of treatment in the presence of anticoagulation, gas gangrene, and extreme debility, rendering the patient unable to heal central and peripheral injury simultaneously. Concomitant K-wire fixation and hip disarticulation preceded by above knee freezing, not previously reported, were used successfully.