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PubMed1988

Treatment of experimental frostbite with urokinase.

An experimental model of frostbite using a standard cold injury in rats was used to test the therapeutic usefulness of the fibrinolytic agent urokinase. Control groups included rapid rewarming, slow rewarming, and slow rewarming followed by saline infusion. Urokinase was administered through an intra-arterial catheter 30 minutes after cold injury and slow rewarming. Optimum results were obtained with rapid rewarming of the extremity at 43 degrees C. However, with rewarming at room temperature eventual tissue loss was significantly decreased with the infusion of urokinase compared with either no treatment or saline infusion. In the clinical situation where the patient with frostbite is seen after slow rewarming, we believe that clinical trials of the use of a fibrinolytic agent are warranted.

Animals↗
PubMed1992

Mountain frostbite. Current trends in prognosis and treatment (from results concerning 1261 cases).

From an experience of a large number (1261) of cases of mountain frostbite, an attempt is made to explain its pathophysiological mechanisms and describe the different modalities which to now allow early prognosis to be made. Laser-Doppler, microwave thermography, nuclear magnetic resonance (31P spectroscopy) and bone scintigraphy (technetium 99) are some of the investigations which deserve a special attention. Treatment is discussed, which still appears to be limited to saving viable tissue, especially for severe frostbite lesions, the only ones which pose problems. Rapid rewarming is a keystone of therapy. The role of haemodilution, vasodilators, sympathetic blockade and surgery is also discussed.

Cold Temperature↗
PubMed1993

Toe-to-hand transfers in the rehabilitation of frostbite injury.

In our experience digitless hands from frostbite injury are typically seen in young men as a result of an episode of intoxication. Such deformities occur bilaterally in 80% of cases and often lead to total loss of prehensile capability. Because of a uniformly high degree of motivation in this group of patients, toe-to-hand transfer carries an excellent prognosis. Microanastomoses in a frostbitten hand are as reliable as in a mechanically injured hand, provided the ulnar artery and its branches are intact. Because amputations occur at the level of the metacarpal heads, the preferred transplant is the combined second and third toe composite. However, a satisfactory thumb post is essential for proper function of the composite. Well-planned sharing of available toe resources is necessary for establishing optimum bilateral hand function, especially in the face of simultaneous toe frostbite. Squandering valuable foot resources bilaterally on behalf of a single hand makes reconstructing the opposite hand more difficult. Economy may be gained if two separate microvascular toe transfers are taken from the same foot or if a single block of toes may be applied to the hand as an opposable unit. Clinical management is described of 25 digitless patients whose frostbitten hands were treated by microsurgical toe transfer.

Adult↗
PubMed1998

An algorithm for early aggressive treatment of frostbite with limb salvage directed by triple-phase scanning.

Frostbite injuries have traditionally been treated with expectant observation. With the exception of early blister aspiration tissues are allowed to demarcate before definitive debridement is accomplished. Triple-phase bone scanning has been used to define the extent of fatally damaged tissues in an attempt to allow for early debridement and wound closure. We suggest extending this technology to assess injury and direct debridement in patients for whom early aggressive salvage attempts are indicated. We present two cases in which triple-phase scanning was used to direct early debridement for aggressive limb salvage with flap reconstruction. Bone, ligament, tendon, and nerve were preserved and covered with vascularized tissue before the onset of frank necrosis. Postoperative scans reveal revascularization of these tissues. An algorithm incorporating triple-phase scanning for the evaluation and treatment of frostbite is presented.

Adult↗
PubMed1991

Severe frostbite caused by Freon gas.

We have reported a case of severe frostbite due to direct exposure to liquid Freon gas (monochlorodifluoromethane), a fluorinated hydrocarbon widely used as refrigerants, propellants, and industrial solvents. The patient was treated for severe third- and fourth-degree frostbite to the hand. The severity of the injury was apparently the result of direct through-and-through injury from exposure to the liquid (boiling point -40.5 degrees C) and a possible systemic vasoconstrictive effect on arterial smooth muscle due to inhalation of Freon gas.

Adult↗
PubMed1991

Spray-induced frostbite in a child: a new hazard with novel aerosol propellants.

A case of deep frostbite occurred in an 8.5-year-old child. The lesion was due to the improper use of a toilet air freshener and was severe enough to require a skin graft. The propellants contained in the spray were propane and butane. We measured the temperature of this aerosol during spraying (-40 degrees) in comparison with an ethyl chloride spray (-3 degrees) widely used for local skin anesthesia. This difference is mainly due to the much lower evaporation temperature of propane (-42.2 degrees) and butane (-0.6 degrees) compared with ethyl chloride (12.5 degrees). This child aimed the spray directly toward his skin, thus producing a deep frostbite. We wish to draw the attention of clinicians to this potential hazard with new propellants, since they should soon replace chlorohydrofluorocarbons throughout the world for ecologic reasons.

Aerosol Propellants↗
PubMed1989

Epidural neurostimulation in the treatment of frostbite.

Epidural spinal cord stimulation (SCS) and conventional treatment produced good therapeutic effects in four young patients with frostbite of the lower limbs. The mechanism of action is unknown but the treatment resulted in rapid recovery with reduced pain and a more peripheral level of amputation. These preliminary results warrant further studies of SCS in the treatment of frostbite.

Adult↗
PubMed1976

Angiography in the diagnosis and therapy of frostbite.

Five patients with frostbite injury were studied by selective angiography and treated by selective intra-arterial application of reserpine with follow-up angiography two days later. Control angiograms showed various degrees of vascular spasm as well as organic stenosis and occlusion. Intra-arterial reserpine produced dramatic subsiding of vasospasm, as evidenced by angiography and relief of clinical symptoms. Complete healing without tissue loss occurred in 4 patients. Amputation was necessary in one case, due at least in part to pre-existing peripheral atherosclerotic disease. Selective angiography was found to contribute significantly to both the diagnosis and therapy of frostbite injury.

Acute Disease↗
PubMed1986

Frostbite: experimental assessment of tissue damage using Tc-99m pyrophosphate. Work in progress.

We designed an experimental model using a new method of freezing to study the pathogenesis and treatment of frostbite. Frostbite was simulated in a manner that closely resembles that which occurs in a natural environment. We used a radionuclide imaging technique to monitor the evolution and extent of tissue damage relative to temperature, rate of freezing, and controlled rewarming. Characteristic sequential changes were demonstrated on sequential nuclear scans. Nonperfusion, followed by perfusion, and finally again by nonperfusion occurred in all areas in which necrosis developed. The reappearance of nonperfusion corresponded to vascular injury and thrombosis evidenced at pathologic examination. We determined that lack of tissue perfusion corresponded to tissue injury. We believe that our experimental model provides an effective means of evaluating potential therapeutic regimens.

Animals↗
PubMed1989

Frostbite injury: prediction of tissue viability with triple-phase bone scanning.

Triple-phase bone scans were obtained in seven patients within 48 hours of admission for frostbite injuries. Three patterns of perfusion imaging and delayed bone imaging were observed: hyperemic blood flow with normal early blood pool and normal delayed bone images; absent blood flow and absent early blood pool depiction, but depiction of bone in delayed images; and absent perfusion and absent blood pool depiction, with no bone uptake in the delayed images. The first pattern indicated mild ischemia that required no surgical treatment, the second indicated ischemia with occasional superficial tissue infarction that required minor debridement, and the third pattern indicated deep-tissue and bone infarction that required amputation. The triple-phase bone scan is a useful indicator of tissue viability as early as 2 days after cold injury and appears to have a clinical role in the evaluation of frostbite injuries. The perfusion and blood pool images demonstrate the ischemic tissue at risk, while the delayed bone scan images demonstrate the extent of deep-tissue and bone infarction.

Adolescent↗
PubMed1984

Assessment of tissue viability in frostbite by 99mTc pertechnetate scintigraphy.

Technetium-99m pertechnetate scintigraphy was performed in the involved extremities of six patients with severe frostbite of the hands (six cases) and feet (one case). There was good correlation between the scintigraphic findings and the extent of deep tissue ultimately requiring surgical resection. Technetium-99m pertechnetate imaging distinguishes viable from dead tissue in frostbite in a simple, noninvasive manner, and findings are easy to interpret. A persistent perfusion defect is seen in nonviable tissue.

Adolescent↗
PubMed1999

Cold injuries. Protecting your patients from the dangers of hypothermia and frostbite.

Hypothermia may occur in any part of the country but is an especially important concern among people who enjoy cold weather sports. Prompt recognition and treatment are paramount, since many hypothermia victims have recovered from very low body temperatures. Therefore, even if someone appears to be dead from exposure to cold, resuscitative efforts should be started and continued until the proper core body temperature is reached. Although frostbite is often considered minor, it can cause permanent tissue damage. Preparation is the key to protecting patients from the effects of cold weather, and frostbite, frostnip, and hypothermia should always be taken seriously. Treatment in a medical facility can make the difference between full recovery and lifelong problems.

Athletic Injuries↗
PubMed1997

[Study on the contents and the activities of antithrombin III in plasma of rats after frostbite].

The changes of the contents and activities of antithrombin III (AT-III) in plasma of rats following frostbite of both hind feet were investigated by means of rocket immunoelectrophoresis and single immunodiffusion. The results showed that the contents and the activities of AT-III were decreased in plasma of rats after frostbite and these changes were closely related to the degrees of cold injury. It is suggested that as a result of depressed anticoagulability, the blood coagulability could be increased after freezing, leading to the dysfunction of circulation and necrosis of local frostbitten tissue ultimately.

Animals↗
PubMed1999

Lumbar epidural sympathectomy for frostbite injuries of the feet.

Fourteen patients with pain and paresthesias secondary to frostbite injury were treated with lumbar sympathetic blockade. The majority of patients had an excellent response to 48 hours of continuous epidural blockade with no recurrence of symptoms after blockade. Those patients who had a limited response to epidural blockade responded well to surgical lumbar sympathectomy. Lumbar sympathetic blockade is a safe and effective technique for treating the symptoms associated with frostbite injury.

Adult↗
PubMed1975

Effects and prevention of frostbite in wound healing.

Observations on wounds sustained at subfreezing temperatures in husky dogs and in man suggested that exposed wet tissues readily become frozen. Frostbite of wounds caused tissue necrosis, wound sepsis and delayed healing, but immediate wound suture protected against this sequence. To explore the effect of wound closure on healing frostbitten tissue, healing of paired dorsal wounds was studied in 20 rats. In each animal one wound was sutured and the other was left open. In 10 animals both wounds were frozen with Dry Ice. All sutured wounds healed primarily. Most of the control open wounds had healed at 15 days, but in the frozen wounds healing was delayed and infection ensued. It is suggested that at temperatures much below freezing the immediate treatment of a wound should include prevention of frostbite by wound closure.

Animals↗
PubMed1975

Treatment of experimental frostbite with intra-arterial sympathetic blocking drugs.

A number of experimental and clinical studies have shown that early regional surgical sympathectomy decreases tissue loss following frostbite, presumably by relieving vasospasm and increasing blood flow. This study was performed to determine if a decrease in tissue loss following a standard cold injury could be obtained following a regional "medical sympathectomy" achieved by the intra-arterial administration of sympathetic blocking drugs. A standard cold injury was produced in rabbits and the animals were divided into nine treatment groups. Various treatment modalities were evaluated, including rapid rewarming, intra-arterial reserpine and tolazoline, and intravenous low molecular weight dextran. In the slowly rewarmed animals, the usual clinic situation, the regional intra-arterial administration of reserpine and tolazoline significantly reduced tissue loss, equalling the results obtained in the rapidly rewarmed group. These results indicate that the early achievement of a regional "medical sympathectomy" may be of benefit in reducing tissue loss following frostbite in patients, especially in those in whom rapid rewarming cannot be performed.

Animals↗
PubMedDate not supplied

[Frostbite of the upper and lower limbs in an expert mountain climber: the value of bone scan in the prediction of amputation level].

A 38 year old man was admitted to our hospital 10 days after suffering a frostbite injury in hands and feet while practicing mountain climbing, at 8,100 meters of altitude, while he was trying to reach the top of the K2 mountain. A 99mTc-MDP bone scan performed in aseptic conditions showed: in hands: absence of bone uptake in the 3rd phalanx and distal portion of 2nd phalanx of the 5th finger of the left hand, and multiple areas of increased uptake in the distal portion of both hands. In feet: uptake decreases in the 2nd phalanx of the first toe of the left foot, and absence of bone uptake in the 3rd phalanx of the 2nd toe of the left foot, and in 2nd phalanx of the 1st toe and 3rd phalanx of the 2nd, 3rd and 4th toes of the right foot. As in the hands, there were multiple areas of increased uptake in the distal portion of both feet. The phalanges with absence of bone uptake had to be amputated, while those that presented increased uptake recovered with conservative treatment. Bone scan is indicated in the evaluation of frostbite injuries and helps to establish the prognosis early.

Adult↗
PubMed2002

[Reconstruction of plantar regions with free radial forearm flaps after frostbite of both feet--case report and literature review].

Treatment of 49 year old male with frostbite of feet is presented. The treatment included reconstruction of plantar surfaces in the both feet. Necrotic tissues were excised seven weeks after the injury and the wounds were split skin grafted. Two staged reconstruction with free neurovascular radial forearm flaps was carried out 15 and 20 weeks after the frostbite. The both flaps healed without complications. The patient recovered touch sensibility in the flap skin after 6 months and than he was able to walk. He returned to his professional job. 12 years after the reconstruction the patient can move freely using orthopedic shoes. His full weight bearing time amounts to 3 hours per day. In case of longer trips he takes elbow crouches with him just for assecuration. Pain and touch sensibility is very good and evenly distributed. 2PD on the plantar surfaces is similar and amounts to 12-15 mm. Meticulous feet care decreased hyperkeratosis thus preventing pressure sore and ulceration. No complications were observed in the donor site.

Foot↗