STUDIES ON GANGRENE FOLLOWING COLD INJURY. VIII. THE USE OF CASTS AND PRESSURE DRESSINGS IN THE TREATMENT OF SEVERE FROSTBITE 1

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Abstract
Prevention of gangrene following exptl. frostbite in the hind feet of rabbits was attempted by mechanical control of edema with casts and pressure dressings. Combinations of rapid warming and subsequent cooling with casts and pressure dressings were also studied. The injuries were of sufficient severity (immersion in liquid for 3 mins. at [long dash] 55 [degree]C) to produce loss of virtually all of the exposed part of the foot in control animals. In similarly injured animals, treated by the above methods, marked improvement was noted. Gangrene was restricted to the toes or parts of the toes in a highly significant number of cases. The most favorable results were obtained by the use of rapid warming followed either by casts applied before swelling occurred or by pressure dressings applied after maximum swelling. Casts or pressure dressings alone produced significantly favorable results. The maintenance of low skin temps. (5-10 [degree]C) in casted frostbitten feet produced better results than casts alone, but the difference was slight. Multiple incisions through the skin of the injured regions, followed by the application of pressure dressings, led to survival of more tissue in the frostbitten feet than was observed in the controls; but the low statistical significance of the difference suggests that the procedure is of doubtful value. External application of pulsating pressure was completely ineffective in preventing gangrene. Various factors influencing the successful use of the treatments have been discussed and a possible mechanism by which control of edema may prevent gangrene was suggested.