Studies on Gangrene Following Cold Injury. I. A Method for Producing Gangrene by Means of Controlled Injury by Cold 1

Fuhrman, Frederick A.; Crismon, J. M.

doi:10.1172/jci101800

Cited by 25 publications

(20 citation statements)

References 2 publications

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“…Rapid thawing of frozen ears in warm water (1 to 3 minutes at + 420 C.) delayed the development of stasis in the true capillaries until maximal swelling was reached at about 2 hours after injury. 6. Procaine block of the stellate ganglion augmented the hyperemia after injury and delayed the onset of stasis for 50 to 60 minutes.…”

Section: Discussionmentioning

confidence: 97%

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Studies on Gangrene Following Cold Injury: Vi. Capillary Blood Flow After Cold Injury, the Effects of Rapid Warming, and Sympathetic Block 1

Crismon

Fuhrman²

1947

J. Clin. Invest.

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Indirect evidence, based upon measurements of skin temperature and observations of skin color in the feet and ears of rabbits subjected to severe cold injury, indicates that complete arrest of blood flow does not occur until more than 50 hours after injury (1). Tests of the local circulation in coldinjured regions with intravenously injected fluorescein show that the exchange of this dye between blood and interstitial fluid is impaired during the interval when the minute volume blood flow is greater than that in comparable uninjured regions (2, 3). Early arrest of blood flow in regions injured by cold has been variously ascribed to "conglutination" of red-cells (4), to capillary stasis (5), and to intravascular clotting (2). While all of the above phenomena may be observed in frostbitten tissues, none has provided an explanation of the nature of local changes in blood flow adequate to account for the maintenance of high peripheral tissue temperature at a time following cold injury when exchanges of oxygen, nutrients, and metabolites appear to be impaired.This report presents the results of microscopic study of blood flow in the small vessels of the ears of rabbits during the first hour after freezing. Blood flow was also studied in the ears of animals which were treated by rapid thawing of the ear in warm water and by procaine block of the stellate ganglion on the injured side. METHODSCold injury was produced by immersing the distal one-half to one-third of the ear for 60 seconds in a mixture of water, ethylene glycol, and alcohol cooled to -550 C. with solid carbon dioxide. Details of this method for the production of controlled cold injury and the characteristic effects on the tissues are given elsewhere (6).X The work described in this paper was done under a contract, recommended by the Committee on Medical Research, between the Office of Scientific Research and Development and Stanford University.Both normal and frostbitten ears of a uniform strain of New Zealand white rabbits were observed through a binocular dissecting microscope having 9X oculars and 4.8X objectives. The light sources was a 100-watt Spencer microscope lamp from which the light was conducted to the ear by means of a polished rod of %-inch methyl methacrylate (Lucite) 2 feet long. The rod was tapered to a cone having a rounded tip 7 mm. in diameter. The distal 8 inches of rod were bent into a curve which presented the brilliantly illuminated tip at a right angle to the original path of light. WiAh the rod in an adjustable clamp, its flattened end in contact with the blue glass of the microscope lamp, the ear was placed under the objectives of the microscope in direct contact with the methacrylate rod. Liquid petrolatum was applied to the shaved ear in order to clear the keratinized epithelium. Photographic recording of the changes observed proved to be unsatisfactory because of the thickness of tissue and the changing optical plane. OBSERVATIONSBlood flow in the capillaries of the normal ear.Movement of blood could not be seen in the larger...

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Section: Discussionmentioning

confidence: 97%

“…Details of this method for the production of controlled cold injury and the characteristic effects on the tissues are given elsewhere (6).…”

Section: Methodsmentioning

confidence: 99%

Studies on Gangrene Following Cold Injury: Vi. Capillary Blood Flow After Cold Injury, the Effects of Rapid Warming, and Sympathetic Block 1

Crismon

Fuhrman²

1947

J. Clin. Invest.

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“…and 2 and 3 minutes at -550 C. Details of standardization of cold injury produced by this means are given in the first paper of this series (7).…”

Section: Methodsmentioning

confidence: 99%

“…Past experience has shown that most cases of accidental injury by cold, especially in military operations, do not receive treatment until a considerable time after exposure, and edema is then usually well advanced. The literature has been reviewed in the first paper of this series (7).…”

Section: Treatment Of Cold Injury By Pulsating External Pressurementioning

confidence: 99%

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Studies on Gangrene Following Cold Injury. Viii. The Use of Casts and Pressure Dressings in the Treatment of Severe Frostbite 1

Crismon¹,

Fuhrman²

1947

J. Clin. Invest.

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It has been reported in a previous communication (1) that increased leakage of fluid from capillaries is an invariable consequence of cold injury in rabbits' ears and feet. Although stasis in the true-capillaries was observed to occur in ears about 10 minutes after injury, it could be delayed by several procedures (2). The delayed appearance of stasis in the treated ears, as well as the invariable late occurrence of stasis at the junction between the normal and frostbitten regions of an ear, suggest that distortion of the tissues, resulting from the massive edema, may close true capillaries and produce stasis. The effect of capillary closure in limiting the exchanges between the blood stream and the cells is an important one.The similarity between the vascular lesion in frostbite and in burns is obvious and has been pointed out previously by others (3). Glenn (4) has recently reviewed the development of the treatment of burns by means of external pressure and by means of non-elastic, non-distensible dressings. Whether the good results of these forms of treatment depend upon "the control of capillary leakage" as suggested by Glenn or whether the benefit may derive from prevention of the mechanical distortion produced by swelling has not been determined. However, measures which aim at the control of either of these consequences of heat injury find equal justification for their use in the treatment of frostbite.Two different types of dressings are available for the mechanical control of fluid loss following injury: I (a) Closed plaster casts were used by Glenn, Gilbert, and Drinker (5) for the treatment of experimental burns. The rationale of this procedure has been described by Glenn (4): "As plasma es- capes from the dilated hyperpermeable capillaries, the extravascular tissue fluid pressure quickly builds up against the rigid encasement to exactly equal the pressure attempting to push fluid out of the capillaries." Such dressings should be skintight, non-elastic and non-distensible. In order to be maximally effective they should be applied before swelling of the injured part has taken place, and they must be applied in such a way that the distal part of the limb is encased in the dressing.(b) External pressure to control fluid loss, as used by Allen and Koch (6) and others, is applied in the form of a pressure dressing of elastic material. A layer of padding separates the tissue from the elastic bandage and serves to equalize the pressures within the dressing. This form of dressing offers no obvious advantages over rigid casts for immediate treatment of frostbite in the period before swelling has begun. METHODSStandard cold injury. Injury was produced by immersing the hind feet of rabbits in a mixture of water, ethylene glycol, and alcohol cooled by the addition of solid carbon dioxide. The times of exposure and the temperatures used included those from 15 to 60 minutes at -15°C. and 2 and 3 minutes at -550 C. Details of standardization of cold injury produced by this means are given in the first paper of this s...

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Localized Cooling in the Central Nervous System

Miyazaki¹,

Ervin²,

Siegfried³

et al. 1963

Arch Neurol

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Studies on Gangrene Following Cold Injury. I. A Method for Producing Gangrene by Means of Controlled Injury by Cold 1

Cited by 25 publications

References 2 publications

Studies on Gangrene Following Cold Injury: Vi. Capillary Blood Flow After Cold Injury, the Effects of Rapid Warming, and Sympathetic Block 1

Studies on Gangrene Following Cold Injury: Vi. Capillary Blood Flow After Cold Injury, the Effects of Rapid Warming, and Sympathetic Block 1

Studies on Gangrene Following Cold Injury. Viii. The Use of Casts and Pressure Dressings in the Treatment of Severe Frostbite 1

Localized Cooling in the Central Nervous System

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