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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.
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Received: April 28, 1961
© 1962 Published by Elsevier Inc.