Controlled environment treatment for limb surgery and trauma (a preliminary report)

This paper demonstrates a new approach to postsurgical and post-traumatic wound management in the lower limbs. Our own results of 20 below-knee amputations are documented. A less detailed report is then given of experience with an additional 20 amputees: this second group includes experience not only here at Seattle but at five other centers in the United States. The same method for wound management and for control of edema was employed in all cases. The method, Controlled Environment Treatment (CET), uses filtered air as a dressing medium, with a control console to maintain the pressure, constant or varying, according to a preset program. Temperature and humidity are also controllable, as is gas composition. The limb, together with its controlled environment, is contained with a pliable, transparent, treatment bag, which permits inspection and palpation of the wound site without disturbing the bacteriologically sterile air within the chamber. A special seal reduces air leakage yet avoids constriction of the limb. This CET system was originally developed by the Department of Health and Social Security, Biomechanical Research and Development Unit, Roehampton, England. Subsequent developments are also noted of an improved Mark II CET Unit and of simpler, related, management systems for conditions not requiring sterile environments.