Case of traumatic spreading gangrene after severe compound fracture of the leg : for which amputation beneath the trochanters was performed and the arteries secured by four acupressure needles... / by P.D. Handyside.

  • Handyside, P. D. (Peter David), 1808-1881.
Date:
[1860]
Catalogue details

Licence: Public Domain Mark

Credit: Case of traumatic spreading gangrene after severe compound fracture of the leg : for which amputation beneath the trochanters was performed and the arteries secured by four acupressure needles... / by P.D. Handyside. Source: Wellcome Collection.

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    oederaatous effusion, with phlyctenaa around the knee; no pulsation in the popliteal, and that in the femoral being 125, and weak. On examining the injured limb under chloroform, the thigh was found, by measurement, one inch thicker than the other, its lymphatics tense, and the inguinal glands much enlarged ; yet, after satisfying myself, first, that the great cavities seemed free from effusion, and from other untoward effects likely to have followed so serious an accident; secondly, that there existed no constitutional contra-indi¬ cation to the removal of the limb at as near a point as possible to the spreading gangrenous inflammation ; and, thirdly, as it seemed thus sufficiently clear that the cause of the gangrene was external, and within reach of the knife,—I therefore advised the immediate adoption of amputation high in the thigh. Being asked by these gentlemen to undertake the responsibility of this operation, I accord- ingly, at 6 P.M., proceeded to remove the limb under chloroform, executing the usual oblique flaps, and sawing the bone just beneath the trochanters, a part of the limb too high for the employment of the tourniquet. Not above giij. of blood were lost; and four needles (improvised for the occasion) sufficed—one for the external flap (on the inner surface of which was compressed apparently an ischiatic branch), and three for the internal flap (on which were compressed, 1st, the femoral, at the point where it gives off the profunda; 2dlv, apparently the obturator; and, 3dly, apparently another ischiatic). (<See the accompanying Woodcut.) Three or four smaller vessels were subjected to torsion only. After stitching together the flaps, slightly wetted lint was applied to the face of the stump, which was then supported with a roller. On removal to his bed, the patient got a little whisky and water, with two grains of opium. On examination of the ablated limb, the muscles of the calf were found extensively lacerated, with intervening coagula of blood ; the arterial trunks were found obliterated by coagula as high nearly as the ham; and the fractured, bruised, and lacerated parts were the seat of sero-purulent and sanguinolent effusion. Four hours after the operation, the patient had not slept, though drowsy, and his mind was still wandering: pulse 108, weak, but soft; skin rather hot, but not too dry ; tongue moister ; complains of very severe pain in the stump, and in his (absent) leg; no trace of haemorrhage. He had now two additional grains of opium. Shortly after this he went to sleep, and slept very softly all night, awakening only occasionally, when he asked his family to leave his room, and then he again fell over to sleep. loth, 10 a.m.—Pulse 104, and improved ; skin more natural ; countenance free from anxiety ; features soft and pleasant; tongue more moist, still furred, yet cleaning; takes soft food, but without •' relish ; wound free of swelling and tension ; femoral artery felt » to pulsate to within an inch of its occluding needle.—At 6 p.m. L ^ revisited W-. Pulse soft, 100, regular; tongue soft, moist, cleaner; appetite returned; asks for bread and milk; skin cool,