Blog administrator’s note: Please read with care. Portions of this post could be disturbing to sensitive readers.
To me, the word “cryoamputation” conjures up images of a shiny, stainless steel laboratory, full of whirring gadgets & blinking lights, a variety of instruments strewn across the table. Perhaps scientists are running around in stylish futuristic lab-gear, holding aloft beakers of glowing chemicals. Or maybe it brings to mind a chisel, hammer, trashbags, and 50 pounds of dry ice.
The latter image would be correct. I have seen cryoamputation performed exactly twice; once on my SICU rotation last month, and again on my General Surgery Sub-Internship. Cryoamputation is a kind of weird, and even slightly barbaric procedure, which helps prevent spread of infection from one body part to another by freezing the infected part solid. Which is where the dry ice comes in so handy.
Call day, 1 am, and the on-call surgery team is consulted to see an elderly female who has a severely infected and very, very gangrenous distal extremity. She is septic (unstable vital signs + infection in her blood), and cannot go to the OR for a formal surgical amputation, as she is too unstable to survive the surgery. In this case, one can perform cryoamputation to stop the spread of infection until the patient is stable enough to go to the OR.
It only requires a handful of basic, inexpensive materials: a trash bag to wrap around the limb, a tourniquet to cut off blood supply to the infected area, a pile of towels for insulation, a special warming blanket to wrap around the part past the soon-to-be-frozen limb, and a whole lot of dry ice. I should note at this point the patient was intubated & heavily sedated, with plenty of pain medication, as this is an incredibly painful procedure.
Unfortunately, we did not realize how difficult it is to find large quantities of dry ice in the middle of the night. Calling all different parts of the hospital with no success, we were eventually informed that someone would have to pick up the supply from Ontario, 45 minutes away from the hospital. A runner was sent, and we prepared the rest of the supplies, eagerly anticipating the arrival of our frozen CO2.
2 hours later, we get a call saying that 50 pounds of dry ice had arrived. After myself, the intern, & senior resident covered ourselves head-to-toe with a ridiculous amount of protective gear (dry ice can and will flash-freeze exposed skin), the senior hauled the massive ice block into a tub, grabbed a chisel & hammer, and proceeded to hammer away. Myself and the intern were frantically scooping up the steaming slivers and chunks and packing them around the patient’s limb. After about 20 pounds were piled up, the mini-glacier & limb were wrapped in towels, and clamped in place. 4 hours later we went to replace the ice, and found the limb was frozen solid. Only time will tell how long this limb will be frozen, or if natural causes will take their course before a much needed formal amputation can occur.
I feel like when people envision surgery, Grey’s Anatomy comes to mind. A group of far too attractive surgeons, clustered around a OR table, elegantly cutting and suturing with the grace of a ballerina. Likely one doesn’t imagine one surgeon, clad in makeshift protective gear, squatting on the floor of the ER, pulverizing a slab of ice with a hammer we stole (temporarily borrowed) from the Orthopedics OR. Sometimes one needs to get a little dirty, and get as far away from the of image glamourous soap opera surgeons in order to save a patient’s life. And really, who wouldn’t want an excuse to play with dry ice?