Frostbite

NewsBot · Oct 3, 2013

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Proposed Treatment Protocol for Frostbite: A Retrospective Analysis of 17 Cases Based on a 3-Year Single-Institution Experience.
Woo EK, Lee JW, Hur GY, Koh JH, Seo DK, Choi JK, Jang YC.
Arch Plast Surg. 2013 Sep;40(5):510-516

BACKGROUND:
This paper discusses the treatment protocol for patients with frostbite.
METHODS:
We performed a retrospective analysis of a series of 17 patients with second- and higher-degree frostbite who had been treated at our medical institution between 2010 and 2012.
RESULTS:
Our clinical series of patients (n=17) included 13 men and four women, whose mean age was 42.4±11.6 years (range, 22-67 years). The sites of injury include the foot in six patients (35.3%), the hand in six patients (35.3%) and the facial region in five patients (29.4%). Seven patients with second-degree frostbite were completely cured with only conservative treatment during a mean period of 12.7±3.3 days (range, 8-16 days). Of the five patients with third-degree frostbite, two underwent skin grafting following debridement, and the remaining three achieved a complete cure with conservative treatment during a mean period of 35±4.3 days (range, 29-39 days). Five patients with fourth-degree frostbite were treated with surgical procedures including amputation.
CONCLUSIONS:
With the appropriate conservative management in the early stage of onset, surgeons should decide on surgery after waiting for a sufficient period of time until the demarcation of the wound. Continuous management of patients is also needed to achieve functional recovery after a complete cure has been achieved. This should also be accompanied by patient education for the avoidance of re-exposure to cold environments.
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Admin2 · Oct 15, 2013

Frostbite

Effect of low temperature on skin and other tissues

This article is about a medical condition. For other uses, see Frostbite (disambiguation).

Medical condition

Frostbite is a skin injury that occurs when exposed to extremely low temperatures, causing the freezing of the skin or other tissues,^[1] commonly affecting the fingers, toes, nose, ears, cheeks and chin areas.^[6] Most often, frostbite occurs in the hands and feet.^[7]^[8] The initial symptoms are typically a feeling of cold and tingling or numbing.^[1] This may be followed by clumsiness with a white or bluish color to the skin.^[1] Swelling or blistering may occur following treatment.^[1] Complications may include hypothermia or compartment syndrome.^[2]^[1]
People who are exposed to low temperatures for prolonged periods, such as winter sports enthusiasts, military personnel, and homeless individuals, are at greatest risk.^[7]^[1] Other risk factors include drinking alcohol, smoking, mental health problems, certain medications, and prior injuries due to cold.^[1] The underlying mechanism involves injury from ice crystals and blood clots in small blood vessels following thawing.^[1] Diagnosis is based on symptoms.^[3] Severity may be divided into superficial (1st and 2nd degree) or deep (3rd and 4th degree).^[2] A bone scan or MRI may help in determining the extent of injury.^[1]
Prevention consists of wearing proper, fully-covering clothing, avoiding low temperatures and wind, maintaining hydration and nutrition, and sufficient physical activity to maintain core temperature without exhaustion.^[2] Treatment is by rewarming, by immersion in warm water (near body temperature) or by body contact, and should be done only when consistent temperature can be maintained so that refreezing is not a risk.^[2]^[1] Rapid heating or cooling should be avoided since it could potentially cause burning or heart stress.^[9] Rubbing or applying force to the affected areas should be avoided as it may cause further damage such as abrasions.^[2] The use of ibuprofen and tetanus toxoid is recommended for pain relief or to reduce swelling or inflammation.^[1] For severe injuries, iloprost or thrombolytics may be used.^[1] Surgery is sometimes necessary.^[1] Amputation should be considered a few months after exposure in order to consider whether the extent of injury is permanent damage and thus necessitates drastic treatment.^[2]
Evidence of frostbite occurring in people dates back 5,000 years.^[1] Evidence was documented in a pre-Columbian mummy discovered in the Andes.^[7] The number of cases of frostbite is unknown.^[5] Rates may be as high as 40% a year among those who mountaineer.^[1] The most common age group affected is those 30 to 50 years old.^[4] Frostbite has also played an important role in a number of military conflicts.^[1] The first formal description of the condition was in 1813 by Dominique Jean Larrey, a physician in Napoleon's army, during its invasion of Russia.^[1]

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v Handford, C; Thomas, O; Imray, CHE (May 2017). "Frostbite". Emergency Medicine Clinics of North America. 35 (2): 281–299. doi:10.1016/j.emc.2016.12.006. PMID 28411928.

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j McIntosh, Scott E.; Opacic, Matthew; Freer, Luanne; Grissom, Colin K.; Auerbach, Paul S.; Rodway, George W.; Cochran, Amalia; Giesbrecht, Gordon G.; McDevitt, Marion (1 December 2014). "Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update". Wilderness & Environmental Medicine. 25 (4 Suppl): S43–54. doi:10.1016/j.wem.2014.09.001. ISSN 1545-1534. PMID 25498262.

^ ^a ^b Singleton, Joanne K.; DiGregorio, Robert V.; Green-Hernandez, Carol (2014). Primary Care, Second Edition: An Interprofessional Perspective. Springer Publishing Company. p. 172. ISBN 9780826171474.

^ ^a ^b Ferri, Fred F. (2017). Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 502. ISBN 9780323529570.

^ ^a ^b Auerbach, Paul S. (2011). Wilderness Medicine E-Book: Expert Consult Premium Edition - Enhanced Online Features. Elsevier Health Sciences. p. 181. ISBN 978-1455733569.

^ "Frostbite - Symptoms and causes". Mayo Clinic. Retrieved 19 February 2021.

^ ^a ^b ^c Handford, Charles; Buxton, Pauline; Russell, Katie; Imray, Caitlin EA; McIntosh, Scott E; Freer, Luanne; Cochran, Amalia; Imray, Christopher HE (22 April 2014). "Frostbite: a practical approach to hospital management". Extreme Physiology & Medicine. 3: 7. doi:10.1186/2046-7648-3-7. ISSN 2046-7648. PMC 3994495. PMID 24764516.

^ Millet, John D.; Brown, Richard K. J.; Levi, Benjamin; Kraft, Casey T.; Jacobson, Jon A.; Gross, Milton D.; Wong, Ka Kit (November 2016). "Frostbite: Spectrum of Imaging Findings and Guidelines for Management". Radiographics. 36 (7): 2154–2169. doi:10.1148/rg.2016160045. ISSN 0271-5333. PMC 5131839. PMID 27494386.

^ "Frostbite and Hypothermia". CT.gov - Connecticut's Official State Website. Retrieved 2 July 2021.

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Admin2 · Oct 15, 2013

Related Threads:
Other threads tagged with cold injury

NewsBot · Feb 28, 2018

Acute Compartment Syndrome of the Foot Due To Frostbite: Literature Review and Case Report
Roberto A. Brandão et al
JFAS; March–April, 2018Volume 57, Issue 2, Pages 382–387

Acute compartment syndrome of the foot and ankle is a relatively rare clinical finding. Lower extremity compartment syndrome is customarily due to vascular or orthopedic traumatic limb-threatening pathologic issues. Clinical correlation and measurement of intracompartmental pressure are paramount to efficient diagnosis and treatment. Delayed treatment can lead to local and systemically adverse consequences. Frostbite, a comparatively more common pathologic entity of the distal extremities, occurs when tissues are exposed to freezing temperatures. Previously found in military populations, frostbite has become increasingly prevalent in the general population, leading to more clinical presentations to foot and ankle specialists. We present a review of the published data of acute foot compartment syndrome and pedal frostbite, with pathogenesis, treatment, and subsequent sequelae. A case report illustrating 1 example of bilateral foot, atraumatic compartment syndrome, is highlighted in the present report. The patient presented with changes consistent with distal bilateral forefoot frostbite, along with gangrenous changes to the distal tuft of each hallux. At admission and evaluation, the patient had increasing rhabdomyolysis with no other clear etiology. Compartment pressures were measured in the emergency room and were >100 mm Hg in the medial compartment and 50 mm Hg dorsally. The patient was taken to the operating room urgently for bilateral pedal compartment release. Both pathologic entities have detrimental outcomes if not treated in a timely and appropriate manner, with amputation rates increasing with increasing delay.
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Rob Kidd · Mar 2, 2018

For those interested in podiatric history - which should be all of you, possibly the most well known frostbite known to podiatric circles was a climber - Robin Hodgkin. If you have access to the 1960's UK journal you will find his picture on the front cover of one leading a climb on Derbyshire gritstone, perhaps 1964. He was involved in an incident on the Masherbrum in 1939, lost all his pedal digits, manual digits 2-5 were down to the proximal phalanx on the right hand and 3-5 on the left. Digit 2 of the left hand was good apart from a piece of the proximal phalanx. Thank goodness he retained both polluxes.

Why do I know this? He was my headmaster in the 60's and taught me to climb; he could climb more ably than me with his tiny boots and not much in the way of pedal anatomy. For those really interested in science, his brother, Alan, was awarded a Nobel prize in 1964, together with his working partner Andrew Huxley. Of course Andrew's grandfather, Tom (Chas Darwin's best mate), started the school of anatomy from which I derive. Proud, or what?

NewsBot · Aug 12, 2023

Evaluating the Efficacy of Hyperbaric Oxygen Therapy in Digital Frostbite
Steven R. Cooperman, DPM, MBA, AACFAS et al
June 30, 2023

Frostbite is a limb threatening, cold-induced tissue injury most commonly affecting the extremities. Hyperbaric oxygen therapy (HBOT) is a proposed adjunctive treatment for this condition, which acts by increasing cellular oxygen availability in damaged tissues. Currently, there is a lack of data regarding the effectiveness of HBOT. Therefore, the purpose of this study is to further the research as one of the largest retrospective comparative cohort studies to date. We evaluated the efficacy of HBOT in the treatment of digital frostbite compared to a non-HBOT-treated group, with a focus on amputation outcomes between each group. A multicenter retrospective cohort study was performed from January 2016 to August 2021 observing patients seen for frostbite. Amputation characteristics and encounter outcomes of patients treated with HBOT were compared to those in patients treated without HBOT. A one-to-one matching of HBOT-treated and non-HBOT-treated patients was also performed, followed by chi-square and Fisher's exact test statistical analysis. The results of the study found a low overall amputation rate of 5.2% across both cohorts. Comparison between groups identified no statistical difference between HBOT and non-HBOT groups regarding amputation characteristics through matched cohort analysis. However, an increased length of hospital stay in patients treated with HBOT (22.2 days) compared to the non-HBOT group (6.39 days) was identified. Based on this study, recommendations for future HBOT studies should evaluate the efficacy of HBOT for more severe cases of frostbite, with additional consideration for cost analysis studies.
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NewsBot · Jan 18, 2024

Frostbite in the Pediatric Population
A Comprehensive Review and a Prospective Canadian Survey
Ma, Xiyaet al
Pediatric Emergency Care ():10.1097/PEC.0000000000003109, January 11, 2024. | DOI: 10.1097/PEC.0000000000003109

Introduction
Frostbite in the pediatric population, where skeletal maturity has not been achieved, can have important repercussions on subsequent growth. Yet, the optimal management of frostbite injuries in children remains vague. This review aims to summarize the current evidence for frostbite management in children and understand Canadian practice trends on this topic.

Methods
A review using Medline, Scopus, Web of Science, and gray literature was performed to identify relevant literature on the clinical manifestations, diagnostic methods, and treatment options in pediatric frostbite. An online survey was sent to plastic surgeons through the Canadian Society of Plastic Surgeons (CSPS) mailing list to further identify national practices and trends for pediatric frostbite management.

Results
A total of 109 articles were reviewed. No article provided a specific algorithm for pediatric frostbite, with existing recommendations suggesting the use of adult guidelines for treating children. Our survey yielded 9 responses and highlighted the rarity of pediatric frostbite cases, with no responder treating more than 10 cases per year. Most (55.6%) do not use a pediatric-specific treatment algorithm, whereas 30% apply adult guidelines. A conservative approach focusing on rewarming (55.6%), limb elevation (50%), and tetanus status verification (66.7%) was predominant. Imaging and surgical interventions seem to be reserved for severe cases.

Conclusions
The current literature for pediatric frostbite management lacks specificity. Canadian practices vary, with a trend toward a conservative approach. The limited evidence and rarity of experience highlight the need for further research, ideally in a collaborative multicentric manner, to create a consensus for pediatric frostbite care.
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Frostbite

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