[Electrical stimulation for rapid assessment of extremity tissues vitality in critical ischemia].
BACKGROUND
In cases of trauma of the extremities, the development of critical tissue ischemia is a frequent complication, requiring surgical intervention with possible amputation. The exact duration of blood supply loss is often difficult to evaluate. Therefore, an easily applicable simple and rapid method for tissues vitality assessment would be of appreciable importance. It could also be used during surgery for delimitation of viable from non-viable tissue.


METHODS
The well-known approach for nerve-muscle excitability assessment by electrical stimulation is adopted. Its simplest form is by visual observation of the tissue reaction to the respective excitation. A battery supplied electrical stimulator is built for this purpose, housed in two hand-held electrode holders. The stimuli parameters were selected for efficient excitation of denervated and partially denervated tissue structures.


RESULTS
The stimulator was used in assessment of the condition of 23 patients: 16 with severe critical arterial ischemia from arterial occlusive disease and seven with vessel trauma and injuries. Eight extremities were tested immediately after amputation.


CONCLUSIONS
The stimulator was shown to be very efficient for tissue vitality assessment in the diagnostic stage. The easiness of use makes it convenient for application in the ambulatory, during transportation, at the patient bedside, as well as during surgery. It can also be efficient in mass accidents, disasters, or in armed conflicts.
Topalov
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I
Département de chirurgie, académie médicale militaire, Sofia, Bulgarie.
Daskalov
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I
D000208:Acute Disease; D000671:Amputation, Surgical; D000672:Amputation Stumps; D001157:Arterial Occlusive Diseases / Q000175:diagnosis*; D001808:Blood Vessels / Q000293:injuries*; D004558:Electric Stimulation / Q000295:instrumentation / Q000379:methods; D004566:Electrodes; D005121:Extremities / Q000098:blood supply / Q000293:injuries*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis*; D013997:Time Factors