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PubMed1999

Effect of acute hypoxia and hypoxic acclimation on hemorheological behavior in rats with frostbite.

It was found that cold injury in rats acclimated to hypoxia was more serious than that in nonacclimated ones. In order to go further into the cause, blood rheological parameters in rats of frostbite at normoxia (FN), frostbite during acute hypoxia (FAH) and frostbite during hypoxia after hypoxic acclimation (FHAC) groups were observed before and after freezing. Before freezing, systemic hematocrit (Hct), blood viscosity, RBC aggregation index and RBC rigidity of FHAC group were higher and RBC deformability index (DI) of FHAC group was lower distinctly than those of FN and FAH groups. After frostbite, the aforesaid changes aggravated prominently, plasma viscosity of FHAC group reduced and was lower than that of FN and FAH groups. The results suggest that the hemorheological behavior is deteriorated in rats acclimated to hypoxia or subjected to freezing, and worsens in hypoxic acclimation rats after freezing. The changes in hemorheological behavior may be one of the causes that would make the frostbite damage more severe in rats acclimated to hypoxia.

Adaptation, Biological↗
PubMed1991

Evidence for an early free radical-mediated reperfusion injury in frostbite.

Frostbite is characterized by acute tissue injury induced by freezing and thawing. Initial complete ischemia is followed by reperfusion and later, tissue necrosis. These vascular events support the hypothesis that free radical-mediated reperfusion injury at thawing might contribute to tissue necrosis after frostbite in a manner similar to that seen after normothermic ischemia. To test this hypothesis, rabbit ears were frozen at -21 degrees C for 30, 60, 90, or 120 s and rewarmed at room temperature (22 degrees C). Rabbits were treated "blindly" with saline alone, highly purified, pharmaceutical grade superoxide dismutase (SOD), allopurinol, or deferoxamine. The area of ear necrosis was determined 3 weeks after frostbite by "blinded" morphometry. The administration of SOD at the time of thawing significantly improved viability in ears frozen for 60 and 90 s, but not in those frozen for 30 or 120 s. Deferoxamine also improved viability in ears frozen for 60 s. Allopurinol did not significantly affect ear survival. Electron micrographs showed the appearance of severe endothelial cell injury beginning during freezing and extending through early reperfusion. Later, neutrophil adhesion, erythrocyte aggregation, and microvascular stasis were seen. These findings suggest that free radical-mediated reperfusion injury has a role in frostbite, and quantitate the proportion of the injury that is due to this mechanism.

Allopurinol↗
PubMed2001

Hyperbaric oxygen treatment in deep frostbite of both hands in a boy.

UNLABELLED: An 11-year-old boy in good general health conditions suffered deep frostbite on six fingers while he was working without gloves as a beater during a hunt in Poland at an outdoor temperature of -32 degrees C over a 4 h-period. Three days later he was first seen by a physician who planned to amputate the affected fingers. The patient was transferred by his family to our University Hospital in Aachen, Germany. We found third degree frostbite on four fingers of the right and on two fingers of the left hand. Because of the late beginning of the therapy, the patient was treated by HBO(2) according to the Marx-schema for problem wounds (2,4 bar, total time at depth: 90 min, alternations of 100% O(2) and air breathing). HBO(2)-treatment was repeated daily for 14 days. No adverse events were recorded during the course of therapy. A total recovery of the severe frostbite was observed after 14 days of HBO(2)-treatment. Twenty-eight months after the injury the patient reports fully regained sensibility and no pain. The plain X-ray after this period showed no premature closure of the epiphyses or sclerosis of the metaphyses. CONCLUSIONS: Because of the low risk associated with HBO(2), and its potential therapeutic efficiency, HBO(2) should be recommended as adjunct therapy in the treatment of deep frostbite.

Child↗
PubMed1998

Defibrotide activity in experimental frostbite injury.

The pathogenesis of frostbite injury has not been completely elucidated although the available evidence suggests it is an inflammatory reaction following reperfusion injury. Defibrotide given i.p. at 40 mg/kg/ day for three days to rabbits, the ears of which were subjected to frostbite, decreased the presence of inflammatory cells (mast cells -76%; neutrophils -40.4%) and increased prostaglandin I2 (PGI2) (as 6-Keto-PGF1 alpha) in the involved skin. Thromboxane A2 (TxA2) (as TxB2) was unaffected. These data strengthen the view that an inflammatory process is the underlying cause of frostbite injury and that Defibrotide is active in pathological situations involving an inflammatory process like in frostbite.

6-Ketoprostaglandin F1 alpha↗
PubMedDate not supplied

Continuous infusion of epidural morphine in frostbite.

After frostbite injury, the phases of rewarming and progressive injury may cause intense pain for the patient. Although parenteral narcotic agents are the usual method of pain relief, they have well-described adverse effects such as heavy sedation, respiratory depression, and nausea and vomiting. In frostbite injury of the lower extremities, epidural blockade has the potential to provide good pain relief with fewer of those complications. However, the associated sympathetic blockade is believed by many clinicians to be of no benefit and by some to be potentially harmful. Epidural narcotics have the selective advantage of providing analgesia without sympathetic blockade. In this case report, the use of continuous epidural morphine during the first 24 hours after severe bilateral frostbite injury to the feet is described. The technique provided effective pain control, and no complications occurred. To our knowledge, use of continuous epidural morphine after frostbite injury has not been reported previously. Further use of this technique will be required to clarify its efficacy.

Adult↗
PubMed1990

Frostbite: predisposing factors and predictors of poor outcome.

A retrospective review of 79 frostbite cases over a 10-year period at a major Northern Canadian hospital was performed. Factors predisposing to frostbite injury and predictors of a poor outcome were sought. Impaired cerebral function was found to be the major predisposing factor to frostbite injury. At the time of injury, 53% of patients were under the influence of alcohol and 16% were suffering from psychiatric illnesses. Lower extremity frostbite, infection, and delay in seeking medical attention were factors found to be associated with a poor outcome.

Adolescent↗
PubMed2000

Frostbite: pathogenesis and treatment.

Frostbite, once almost exclusively a military problem, is becoming more prevalent among the general population and should now be considered to be within the scope of the civilian physician's practice. Studies into the epidemiology of civilian frostbite have identified several risk factors that may aid the clinician in the diagnosis and management of cold injuries. Research into the pathophysiology has revealed marked similarities in inflammatory processes to those seen in thermal burns and ischemia/reperfusion injury. Evidence of the role of thromboxanes and prostaglandins has resulted in more active approaches to the medical treatment of frostbite wounds. Although the surgical management of frostbite involves delayed debridement 1 to 3 months after demarcation, recent improvements in radiologic assessment of tissue viability have led to the possibility of earlier surgical intervention. In addition, several adjunctive therapies, including vasodilators, thrombolysis, hyperbaric oxygen, and sympathectomy, are discussed.

Clinical Protocols↗
PubMed2002

Imaging of frostbite injury by technetium-99m-sestamibi scintigraphy: a case report.

The appearance of superficial tissue is often an unreliable indicator of deep-tissue viability in cases of frostbite. We present a 34-year-old black man who was brought to the emergency department at fourth post-injury day with frostbite injury involving both lower extremities after prolonged exposure to subzero temperatures. In our previous experimental study, 99mTc sestamibi scintigraphy has been employed for evaluating frostbite injuries in rabbit hindlegs. In the case presented, 99mTc sestamibi scintigraphy, as a new diagnostic tool, was performed for detection of skeletal muscle perfusion on the fourth post-injury day. The scintigraphic images show diffusely reduced uptake in soft tissues of both calves and feet. It was thought that this hypoperfusion was due to viable but ischemic tissue. Five days after medical therapy, 99mTc sestamibi scan showed prominently increased uptake in both calves and feet and skin necrosis was observed. Debridement of necrotic skin and subcutaneous tissue was performed, and split-thickness skin graft was applied for coverage of the skin defect. Healing was good 15 days after grafting. We think 99mTc sestamibi scan can be used for assessment of soft-tissue perfusion and evaluation of treatment in frostbite injury.

Adult↗
PubMed2001

Retrospective study of 70 cases of severe frostbite lesions: a proposed new classification scheme.

OBJECTIVE: Previous frostbite classifications were mainly based on retrospective diagnosis and, most of the time, could not be used to predict the final outcome of the lesions and especially the probability of an amputation and its level. The aim of this study was to suggest a new classification at day 0 based mainly on the topography of the lesions and on early bone scan results, which are more convenient and accurate in predicting the final outcome of frostbites. METHODS: The retrospective study of the clinical histories of 70 patients hospitalized at Chamonix Hospital (Mont-Blanc Massif) from 1985 to 1999 for severe frostbite injuries of the extremities has allowed us to classify the aspects of the initial lesions on day 0 and to compare them with final outcomes. RESULTS: A strong correlation was found between the extent of the lesion and the outcome of each finger or toe. When the initial lesion was on the distal phalanx, the probability of bone amputation was around 1% for the digit, 31% for the middle phalanx, 67% for the proximal phalanx, 98% for the metacarpal/metatarsal, and 100% for the carpal/tarsal. CONCLUSIONS: Based on these clinical results and on the results of bone scans (previously validated), a new classification of frostbite severity at day 0 is proposed. Four degrees of severity are defined: first degree, leading to recovery; second degree, leading to soft tissue amputation; third degree, leading to bone amputation, and fourth degree, leading to large amputation with systemic effects.

Adult↗
PubMed1999

Frostbite: an orthopedic perspective.

Frostbite injury to the extremities has the potential for disastrous effects. This review provides information valuable to the orthopedic surgeon to aid in the evaluation and treatment of frostbite. The pathophysiology and predisposing factors that provide a basic understanding of the nature of frostbite are discussed. Accepted and experimental imaging studies and treatment options are also reviewed. An effort is made to give the orthopedic perspective on each issue, providing a valuable resource for all orthopedic surgeons involved in the care of the patient with frostbite.

Combined Modality Therapy↗
PubMed2002

[Frostbite in modern fighting pathology].

In modern war 1-2% in the structure of fighting surgical pathology constitute the frostbites. In cold time of year their frequency increases up to 10%. Late admission of the injured to the stages of medical evacuation, their different and often limited diagnostic and therapeutic potentials influence on the outcomes of frostbites' treatment. The role of rational operative treatment with the use of surgical dermato-plastic methods rises. The analysis of periods, outcomes of treatment, restoration of working capacity and fitness for military service after the frostbites of different degrees and levels of injury permits to propose the military-and-medical classification of this trauma type. Slight, moderate and severe frostbites were selected. The places of final treatment of the injured with reference to the classical scheme of treatment- and evacuation support under conditions of the local armed conflict were determined.

Frostbite↗
PubMed1992

[A case of extra-adrenal pheochromocytoma with frostbite in extremities].

We describe a patient who presented frostbite in extremities in addition to characteristic symptoms, such as severe hypertension, sweating attacks, palpitations and headache. The patient was eventually diagnosed as having single extra-adrenal pheochromocytoma. The frostbite in extremities rapidly resolved after the removal of the tumor as well as other characteristic clinical symptoms. It is speculated that this frostbite might have been induced by severe continuous constriction of peripheral artery and loss of heat by frequent sweating attacks. Regarding cutaneous symptoms in this disease, pallor, acrocyanosis and cold extremities are commonly found. However, it seems that typical frostbite associated with pheochromocytoma has not been reported so far.

Adult↗
PubMed1992

Enzyme histochemical reactions at the demarcation line in frostbite: an experimental study on rabbits.

Eleven frostbites were induced on the ears of seven New Zealand White rabbits and specimens were taken from the lesion after 1, 4 and 8 hours, and from ten further frostbites on the ears of six rabbits for examination 1, 3 and 7 days later. The specimens were taken at the border between the frozen and non-frozen skin. NADH-diaphorase, alkaline phosphatase and esterase were demonstrated histochemically in the sample, which was also studied by haematoxylin and eosin staining. Five ears served as controls. Some granulocytes could be seen accumulating in the vessels and in the dermis at the border of the frostbite area after only 1 hour, and other enzyme rich cells (macrophages) also began to appear. After 4 hours the inflammation was quite obvious with the enzyme reactions clearly observable in the sections. After 8 hours there was no marked difference compared with the 4-hour picture. It was only after 3 days that the line of demarcation between the normal and frostbite tissue could be seen clearly. This was oblique in some specimens and vertical in others. The degeneration in the lesion could best be demonstrated by the NADH-diaphorase and esterase reactions and the early inflammation by the alkaline phosphatase reaction.

Alkaline Phosphatase↗
PubMed1991

Frostbite in reindeer herders.

The aim of this study was to determine the prevalence of frostbite among reindeer herders and to clarify the co-factors that may relate to these injuries. 2081 (60%) male reindeer herders in Finland were asked information on frostbite. Logistic regression analysis was used for studying the effect of potential co-factors. 453 men (22% of the respondents) reported frostbites during the last twelve months, the areas most affected being the face, fingers and toes. The amount of time spent in snowmobile driving, white finger symptom and the area of reindeer herding proved to be significant explanatory factors. Since the majority of frostbites were associated with snowmobile driving in spite of protection and adaptation to cold, it seems that new technology has not solved all the problems of the working conditions in a cold environment.

Adult↗
PubMed1980

Early sympathetic blockade for frostbite--is it of value?

Sympathectomy has been advocated in the therapy of acute frostbite because ischemia is one determinant of injury severity. Among 66 frostbite victims treated from 1976 through 1978, a group of 15 patients with acute, bilaterally equal injuries judged to be third or fourth degree were treated with immediate intra-arterial reserpine (IAR) in one limb and ipsilateral sympathectomy. Three additional patients who were excellent candidates underwent immediate sympathectomy. The average interval from injury to IAR injection was 3 hours (range 1 to 24 hours). The average interval from injury to sympathectomy was 3 days (range, 12 hours to 10 days). Efficacy of therapy was assessed by comparison of the sympathectomized limb to the contralateral untreated limb. There was no conservation of tissue, resolution of edema, pain reduction, or improved function in sympathectomized limbs compared with those treated with IAR. One patient demarcated more rapidly and one other patient appeared to be protected from recurrent injury. Sympathectomy was not effective therapy for acute frostbite even when achieved early with IAR. Late protection against subsequent cold injury appears to be the only benefit of sympathectomy for frostbite.

Adolescent↗
PubMed1993

[Furacilin compound cream for profound frostbite].

Furacilin compound cream in the treatment of profound frostbite was studied. The results of animal experiment showed that furacilin cream might greatly reduce vascular permeability of frostbite. The average survival rate of frostbite tissue increased from 12.0 +/- 1.2% in the control group to 62.0 +/- 3.7% in the treated group. The difference between the two groups was statistically significant (P < 0.001). Five patients with profound frostbite were clinically treated with the cream with satisfactory results.

Adult↗
PubMed1977

Studies on heat output from the hand of frostbite subjects.

We studied 12 subjects, who had suffered first- to third-degree frostbite at high altitude during winter, at Delhi, India. At normal sea level pressure there (PB 740 mm Hg) and in a decompression chamber at a simulated altitude of 4085 m, the studies were at both 26 degrees C and 6.8 degrees C. A group of control (non-frostbite) subjects of comparable age were also studied for their heat output at 26 degrees C, PB 740 mm Hg. Heat output from the hands of a group of mountaineers from the sea level was also studied at 2121 m at 25 degrees C and 4485 m at 7 degrees C. The results indicated that the frostbite subjects had a significantly higher heat ouput at PB 740 mm Hg and 26 degrees C than the non-frostbite subjects. When the former were tested at sea level (PB 740 mm Hg) at 6.8 degrees C, the hand heat output showed a marked and significant decrease. On testing them at a simulated altitude of 4085 m at 26 degrees C and at 6.8 degrees C, a very highly significant reduction in hand heat output was observed compared to their initial value at sea level (740 mm Hg) and 26 degrees C. Their hand heat output also showed a very highly significant decrease compared to mountaineers at 4485 m and 7 degrees C.

Adult↗
PubMed1998

Efficacy of pentoxifylline with aspirin in the treatment of frostbite in rats.

The efficacy of pentoxifylline--a haemorrheologic agent along with aspirin--an analgesic agent was evaluated in the amelioration of the tissue damage due to experimentally induced frostbite in 5 groups (20 each) of rats with body weights ranging between 175 and 200 g. Frostbite was produced experimentally in the hind limbs by exposing the animals to -15 +/- 1 degrees C for 1 h using the harness technique, with simultaneous recording of rectal and environmental temperatures. The degree of tissue damage was assessed on the basis of tissue necrosis after 15 days. Administration of pentoxifylline (40 mg/kg bw) 30 min before and 30 min after the cold exposure followed by two doses of the same daily for the next 5 days along with aspirin (5 mg/kg bw) twice daily for the same duration only after cold exposure, resulted in significant improvement in the degree of tissue preservation. The findings of this preliminary study have brought to light the potential usefulness of these drugs in the treatment of frostbite. The combined pharmacological properties of these two drugs might have altered the haemorrheologic status of blood and produced the curative beneficial effect in improving tissue survival following experimentally induced frostbite in rats.

Animals↗