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Physiologic amputation prevents myoglobinuria from lower extremity myonecrosis
G B Winburn1, M L Hawkins, M C Wood
1Department of Surgery, Medical College of Georgia, Hospital and Clinics, Augusta.
Southern Medical Journal
|October 1, 1993
Summary
Physiologic amputation effectively treated myonecrosis and myoglobinuria in critically ill patients, preventing acute kidney injury. This limb-sparing technique offers a viable alternative when emergency amputation is too risky.
Area of Science:
- Nephrology
- Trauma Surgery
- Critical Care Medicine
Background:
- Myonecrosis leading to myoglobinuria is a significant cause of renal failure in critically ill patients.
- Physiologic amputation (cryoamputation) is an established treatment for severe lower extremity conditions.
Purpose of the Study:
- To evaluate the efficacy of physiologic amputation in critically ill patients with lower extremity myonecrosis and myoglobinuria.
- To assess the impact of physiologic amputation on renal function and creatine phosphokinase levels.
Main Methods:
- Retrospective study of five critically ill patients with lower extremity myonecrosis and myoglobinuria.
- Patients were too ill for emergency amputation and underwent physiologic amputation.
Main Results:
- Myoglobinuria resolved within 24 hours in four of five patients post-physiologic amputation.
- Creatine phosphokinase levels significantly decreased within 48 hours.
- Two patients developed transient renal insufficiency, with one requiring dialysis.
Conclusions:
- Physiologic amputation is a safe and effective treatment for myonecrosis and myoglobinuria in critically ill patients.
- This limb-sparing approach can prevent acute kidney injury in high-risk patients.
- It serves as a crucial alternative when immediate surgical amputation is not feasible.