Treatment of gangrene of the feet and legs by walking.
نویسنده
چکیده
DURING recent decades necrosis of the lower extremities has almost invariably led to the complete bed rest of the patient. The present editions of commonly used medical texts in discussing the treatment of such patients assume that they are confined to bed. Bed rest results in decreased blood flow. Disuse atrophy follows, bone is absorbed, and muscles waste. The skin loses its turgor, nails and hair grow less rapidly, and pulses become less strong. Dietrick, Whedon, and Shorr" 2 showed that at bed rest patients were in negative nitrogen and calcium balance. They also demonstrated that this process could be reversed by keeping the patient in motion in an oscillating bed. One of the greatest stimuli to the development of collateral blood flow in the legs is walking. Thoma3 in 1884 found that the growth of collateral blood vessels was directly proportional to blood flow through them. This work was confirmed by Lewis.4 Along with the rest of the medical profession we were hesitant to allow patients with gangrenous limbs to walk. The success of our surgical colleagues, however, in the treatment of fractures by exercise suggested that we might profit by their experience. We were particularly impressed by the work of Bohler,5 who developed the walking cast for fractures of the ankle. Before the advent of potent antimicrobial drugs, gangrene was feared because of the spreading infection that followed. Gas gangrene and septicemia often were sequelae. Amputa-
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ورودعنوان ژورنال:
- Circulation
دوره 15 5 شماره
صفحات -
تاریخ انتشار 1957