This paper is only available as a PDF. To read, Please Download here.
Abstract
The clinical manifestations of phlegmasia cerulea dolens have been described. The
local features are acute, excruciating pain, cyanosis with extreme tissue anoxia,
and rapid swelling of the limb. The skin is cooler and the pulse volume gradually
diminishes until complete arrest of the circulation occurs. Unless circulation is
rapidly re-established, gangrene is inevitable. We believe that arterial clotting
can occur in the late stage of this disease. A case is reported to support this statement.
The pathologic aspects of this condition have been discussed. Complete blockage of
the venous return is the initiating cause, leading to circulatory arrest and extravasation
of fluid into the tissues. This massive edema with the increased tension within the
fascial compartments may lead to gangrene. Arteriospasm may be an aggravating factor,
but appears to play only a secondary role.
The management of these cases has been discussed. Sympathectomy, paravertebral blocks,
and vasodilators are contra-indicated. Anticoagulants are recommended only when the
tense limb has been decompressed. Exploration of the vessels with thrombectomy or
ligation does not appear to be very effective. Passive exercises to reduce the tension
in the limb are not without risk of pulmonary embolism which may prove fatal.
We recommend decompression by fasciotomies to relieve the tension within the fascial
compartments and thus to restore circulation. A case is reported in which this procedure
was followed with an excellent result.
Management of any tissue necrosis which may occur should be treated conservatively.
Amputation should only be resorted to in cases in which there is extension of the
lesion and in the presence of sepsis and toxemia.
Any underlying disease should obviously be treated.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Special problems in venous thromboembolism.Ann. Surg. 1957; 146: 499
- Massive thrombophlebitis.Lancet. 1957; 1: 343
- Phlegmasia cerulea dolens and gangrene associated with thrombophlebitis.Surgery. 1949; 26: 16
- Acute massive venous occlusion in the lower extremity.Ann. Surg. 1952; 135: 262
Gasson, J. E.: Personal communication, 1961.
- Gangrene of the extremities of venous origin.Circulation. 1950; 1: 225
- Acute massive venous occlusion of the lower extremity.Ann. Surg. 1953; 137: 543
- Thrombophlebitis with ischemia and gangrene.Surgery. 1953; 34: 296
- Thrombophlebitis cerulea dolens—treatment by passive exercise with production of pulmonary embolus.A. M. A. Arch. Surg. 1960; 80: 350
- Phlegmasia cerulea dolens.Angiology. 1954; 5: 472
- Phlegmasia caerulea dolens.Brit. M. J. 1953; 2: 1351
- Phlegmasia cerulea dolens—success treatment by vena cava ligation.Surgery. 1951; 30: 718
- Acute massive venous occlusion. Report of a case successfully treated with exercise.Ann. Int. Med. 1954; 40: 361
- Thrombophlebitis—the role of vasospasm in the production of the clinical manifestations.J. A. M. A. 1940; 114: 117
- The role of serotonin in experimental pulmonary embolism.Surg. Gynec. & Obst. 1955; 101: 691
- A case of phlegmasia cerulea dolens.Brit. M. J. 1952; 2: 1183
- Acute massive venous occlusion of the lower extremities.Surgery. 1951; 29: 355
Article info
Publication history
Received:
April 28,
1961
Identification
Copyright
© 1962 Published by Elsevier Inc.
