Evaluation of Scully et al for the Surgical Criteria of Muscle Viability During Debridement

 

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