>.iAKCH 9, 1906.] 



SCIENCE. 



393 



president of the American Security and Trust 

 Company, Washington, D. C, is the treasurer 

 and General Calvin De Witt, 1707 21st Street, 

 Washington, will gladly supply literature. 

 G. M. K. 

 Geobgetown Univebsitt, 

 February 15, 1906. 



SPECIAL ARTICLES. 



RESULTS OF A REPLANTATION OF THE THIGH.' 



It has previously been shown that a satis- 

 factory circulation may be established in a re- 

 planted thigh.^ 



We wish here to record a summary of ob- 

 servations made on a similar experiment 

 extending over a longer post-operative period. 

 The animal employed was a small white 

 bitch. Through a longitudinal incision the 

 vessels of the thigh were exposed and cut 

 above the point of Scarpa's triangle. The 

 skin was circularly severed and the thigh com- 

 pletely amputated above the junction of its 

 lower and middle third. After a few minutes 

 the limb was replanted. The ends of the 

 bone, the muscles, the vessels and the sciatic 

 nerve were united. The circulation was re- 

 established after having been interrupted for 

 one and one quarter hours. The pulsations 

 of the popliteal and ' saphenous ' arteries were 

 normal. The dark blood circulated very 

 actively through the femoral and saphenous 

 veins. Red blood flowed from the small 

 arteries of the peripheral part of the cut limb. 

 The skin was sutured and a plaster dressing 

 applied to the limb and trunk. 



After the operation the general and local 

 conditions of the animal remained very satis- 

 factory. It dranlc and ate normally and 

 walked on its three sound limbs. The skin 

 of the replanted foot remained normal, but 

 its hue was redder and its temperature higher 

 than that of the normal foot. The anterior part 

 of the foot soon became moderately swollen. 



Seven days after the operation the dressing 

 was partially removed. The limb presented 

 ' From the Hull Physiological Laboratory, Uni- 

 versity of Chicago. 



' Carrel and Guthrie, ' Complete Amputation of 

 the Thigh with Replantation,' The American 

 Journal of the Medical Sciences, February, 1906. 



neither oedema nor trophic troubles. The 

 oedema of the anterior part of the foot was 

 doubtlessly due to pressure by the lower edge 

 of the bandage, as the swelling completely 

 disappeared within a few hours after correct- 

 ing the fault of the dressing. The skin 

 was normal and the wound had united 'per 

 primam intentionem ' without evidence of in- 

 flammation. The temperature of the skin 

 was higher below than above the line of 

 suturing. 



Eight days after the operation the foot ap- 

 peared normal in size, all oedema having dis- 

 appeared. 



On the tenth day, during the afternoon, the 

 temperature of the replanted foot became 

 lower, i. e., similar to that of the normal foot. 

 The dressing was then removed. It was 

 found that, owing to a slipping of the plaster 

 bandage, some urine had got into the cotton 

 dressing and caused infection of the upper 

 part of the longitudinal incision. A small 

 subcutaneous abscess had developed, along the 

 vessels. The general conditions of the ani- 

 mal were excellent, and the nutrition of the 

 limb satisfactory. As the arterial pulsations 

 were much weakened and as it was considered 

 important to accurately determine the cause 

 of this change, the animal was etherized and 

 the vessels examined through cutaneous in- 

 cisions, after which the animal was killed. 



This dissection ' in vivo ' gave the following 

 results : The point of the vascular anastomoses 

 was surrounded by the small subcutaneous 

 abscess. The venous anastomosis was good. 

 The arterial anastomosis was partially oc- 

 cluded by a small clot. All the other portions 

 of the vessels appeared perfectly normal. The 

 circulation through the limb was yet satis- 

 factory, as the obliteration of the anastomosis 

 was not complete. The union of the skin, the 

 muscles and the sciatic nerve was normal. 

 The process of consolidation of the bone was 

 beginning. It is probable, but not certain, 

 that if the animal had been allowed to live, 

 the arterial stenosis would have gradually in- 

 creased and that in the end the circulation 

 would have been interrupted. Then, no 

 doubt, gangrene of the limb would have oc- 

 curred, which result would have been due 



