Vol.. 8, 1922 
PATHOLOGY: W. S. HALSTED 
185 
that replantation of an entire limb may be possible when and even when 
the main artery and vein have been previously ligated. The story of the 
successful case is as follows: November 1, 1920, Dr. Reid replanted the 
left hind leg of a dog. Ten days later Dr. Reichert ligated the femoral 
artery and vein of the opposite (right) leg for the purpose of making 
X-ray studies of the anastomotic circulation. On June 6, 1921, 7 months 
thereafter, Dr. Bidgood and Dr. Reichert amputated through the right 
thigh of this dog — -bone undivided, having forgotten that the main vessels 
of this leg had been previously tied. They were surprised therefore to 
find that these vessels had become converted into fibrous cords and nat- 
urally feared that the replanted leg would become gangrenous. Finding 
later that the leg would live, we regretted that the obliterated vessels had not 
been severed. Hence Dr. Reichert excised a portion of each of the fibrous 
cords and examined them microscopically. Not only had the lumina be- 
come obliterated but the strands consisted of nothing but white fibrous 
tissue, the muscle and elastic tissue of the coats having disappeared. 
Whatever may be the explanation of this successful replantation in one 
act, the result is remarkable — ^almost beyond belief. This experiment 
will of course be repeated, many times if necessary, and Dr. Reichert 
has made the preliminary ligation of the femoral artery and vein in a num- 
ber of dogs with the intention of practising the amputation and replan- 
tation at various periods thereafter. 
Surgeons can best comprehend the perfection of technique required 
for conducting such experiments. Were it not for the fact that well 
nourished tissues can take care of many organisms few wounds would 
heal by first intention. But in the replantation experiments unusual 
precautions have to be taken for the reason that a devitalized limb pre- 
sumably has little power to resist infection. Of the two surfaces which 
we are asking to unite, one is for a time quite dead if all the structures 
have been divided. When the artery and vein have been left for secondary 
ligation little imperfections in technique need not be disastrous. The 
impossibility of having up to the present time an absolutely perfect tech- 
nique may possibly account in part for the fact that the replantations 
have not succeeded when all the structures have been divided except in 
the one instance. It is, however, astonishing, I may say hardly believable, 
that the complete replantation should have been successful even after 
preliminary ligation of the artery and vein. Having once been accom- 
plished, an occasional repetition of the success may safely be predicted. 
With a technique still further perfected we might find that without pre- 
liminary ligation of the main vessels a complete replantation is occasion- 
ally possible. 
After 16 days and probably earlier the new lymphatics crossing the 
scar are demonstrable by injection. This is perhaps the most satisfactory 
functional proof we have of the regeneration of lymphatics. 
