Scully et al evaluated the standard criteria used by surgeons to determine if skeletal muscle is viable during debridement. The authors are from the US Army with service in Korea and Japan.
The standard criteria are the 4 C's:
(1) color
(2) consistency
(3) circulation (bleeding)
(4) contractility on stimulation
Color grades:
(1) dark red
(2) red
(3) pink
(4) pale
Consistency grades determined by grasping the muscle with forceps:
(1) mushy
(2) stringy
(3) soft
(4) firm
Circulation (bleeding) grades: 0, 1+, 2+, 3+ (normal = 3+)
Contractility grades: : 0, 1+, 2+, 3+
In general, no single criteria can be used to determine if muscle is viable or not.
Color was of no value in discriminating viable from nonviable muscle.
Histologic evidence of injury was graded as:
(1) minimal
(2) slight
(3) moderate
(4) marked
(5) complete (necrotic)
To simplify the analysis, I batched the first 3 groups into a viable group and the last 2 groups as nonviable group. I then collated the data from Scully tables as follows.
|
Parameter |
Finding |
Significance |
|
contractility |
1+ to 3+ |
18 of 19 (95%) showed little to moderate damage |
|
|
0 |
21 of 41 (51%) showed marked or complete damage |
|
circulation (bleeding) |
2+ to 3+ |
13 of 14 (93%) showed little to moderate damage |
|
|
1+ |
15 of 21 (71%) showed little to moderate damage |
|
|
0 |
15 of 25 (60%) showed marked to complete damage |
|
consistency |
firm or red |
31 of 36 (86%) showed little to moderate damage |
|
|
mushy or stringy |
17 of 24 (71%) showed marked or complete damage |
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
