This 54 year old female former smoker had a complicated surgical history at the Hospital University of Pennsylvania: lumbar sympathectomy in 1965, femoral-popliteal bypass in 1966, amputation of her 4th and 5th toes later in 1966 and occlusion of her bypass graft. In October 1976, she presented with a gangrenous big toe. A partial amputation of her big toe was performed as her vascular tests suggested that healing of a transmetatarsal amputation was unlikely. It was hoped that a small wound with a generous flap might heal. Postoperatively, in spite of a six week stay in the hospital and a month of treatment with the Syncardon, her toe did not heal. She was discharged with cellulitis of the toe stump and claudication of 0.5 to 2 blocks. A few months later she was readmitted to the University Hospital for treatment with the Circulator Boot. At that time her pain made ambulation and bedrest impossible. She slept sitting in a chair and took Percodans every other hour. The vascular surgeon in charge of the vascular laboratory was kind enough to make pulse volume tracings of her calf and ankle before and after her first treatments.

His baseline curve was flat at the ankle.

He telephoned us immediately after performing a test 15 minutes after her treatment to let us know he had found some flow at the ankle... which he allowed would probably disappear in several minutes.

Two hours later he called again to notify us the improvement in flow had persisted.

After one week of boot therapy, the PO2 levels in her toe increased 4-fold (measured by the polarographic method with the oxygen tension in her maximally dilated arm taken as 100%) and the blood pressure at her ankle had more than doubled. By three weeks the latter had tripled. The picture at the left shows her foot at the time of discharge from the hospital. A small ulcer was still present and found later to communicate with an osteomyelitis of her stump. Subsequently, she again returned to the hospital and underwent a successful transmetarsal amputation with the support of boot therapy. At the request of the Hospital Utilization Committee, she was discharged before her foot had entirely healed and she returned to work with a small ulceration. Her referring surgeon wrote us tht two years later she was still working and had completely healed.