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PubMed1981

Management of frostbite injuries.

The role of interventional radiology in the management and diagnosis of frostbite injury in 18 patients at the West Side VA Medical Center is presented. Conservative treatment and the use of intra-arterial long acting vasodilators, such as reserpine, are emphasized, even in patients referred 48 to 72 hours after the initial injury. This modality of treatment should be attempted before surgical decision or amputation is necessary. Satisfactory responses were obtained in most of the treated subjects and in some cases, results were dramatic with significant recovery and a minimum of sequelae. Generally clinical principles and physiopathology in frostbite injuries are reviewed.

Angiography↗
PubMed1980

Frostbite in Saskatoon: a review of 10 winters.

In a review of 101 patients suffering from frostbite who were admitted to hospitals in Saskatoon during 10 winters, it was found that alcohol consumption was a contributing factor in 39 patients and a motor vehicle accident or breakdown in 33 others. Sixty-six patients underwent primary treatment in Saskatoon, the other 35 were referred for management of demarcated gangrene. Two hospitalized patients died, both of causes unrelated to the frostbite. The preliminary results of bone scanning with radioactive technetium methylene diphosphonate in frostbitten patients suggest that this is not a good prognostic indicator of the ultimate extent of tissue loss until 5 days have elapsed from the time of exposure. The lesion appeared to decrease in extent and increase in depth over a 3-week period. The mainstays of treatment remain rapid rewarming and adequate delay before conservative débridement or amputation. The delay allows healing of partial-thickness injuries and demarcation of full-thickness injuries. One third of patients receiving primary care in Saskatoon required amputation.

Adolescent↗
PubMed1993

Experimental studies on the treatment of frostbite in rats.

The effect of treatment by high dose of vitamin C, rapid rewarming by 37 degrees C water alone and with vitamin C, rapid rewarming by 37 degrees C decoction of Indian black tea alone and with vitamin C for experimentally produced frostbite was evaluated in 6 groups (25 each) of rats. Frostbite was produced experimentally in the hind limbs by exposing the animals at -15 degrees C for 1h using the harness technique. The degree of injury was assessed and classified on the basis of tissue necrosis at the end of 15 days. Administration of high dose of vitamin C for prolonged period and rapid rewarming at 37 degrees C water bath immediately after cold exposure apparently reduced the tissue damage. High dose of vitamin C therapy preceded by rapid rewarming in plain water showed additional benefit. Rapid rewarming in decoction of Indian tea resulted in identical beneficial effect. The degree of tissue preservation was highest with rapid rewarming in tea decoction followed by high dose of vitamin C.

Animals↗
PubMed1995

[The value of technetium scintigraphy for early diagnosis and therapy of severe frostbite].

Frostbites often present with a discrepancy between skin lesions and damage to deeper structures. 14 patients with the diagnosis of severe frostbite and/or hypothermia had been treated between 1990 and 1993. In addition to our standard approach including history, physical exam, and Doppler/Laser-Doppler studies, we performed technecium 99 scintigraphies in seven patients at three to five days after injury. In six patients (86%), there was an excellent correlation between scintigraphic and intraoperative findings. We conclude that early diagnosis and treatment of avital tissue reduces length of hospital stay and allows for maximum amputation stump length preservation.

Adolescent↗
PubMed1998

[Frostbite as a problem for dermatoplastic surgery].

An analysis of the 35-years experiences with treatment of 621 patients with the IV-degree frostbite of hands and feet is presented. The surgical strategy of treatment of frostbite has undergone considerable evolution for these years. In addition to classical surgical treatment, the surgeons began to widely use methods of dermo-plastic surgery which allowed not only to save the maximum possible length of the extremity segment stump, but also to reduce the frequency of purulent complications and reamputations and thus to shorten the duration of hospital treatment.

Adolescent↗
PubMed1990

Long term sequelae of frostbite.

Frostbite injury in the hands and feet of a child can have long-term sequelae, Premature fusion and abnormal growth can occur in the epiphyseal cartilage.

Bone Development↗
PubMed1982

Histologically demonstrable vital reactions to frostbite in guinea pigs dying of hypothermia.

Vital reactions in the paw skin of guinea pigs dying of hypothermia were examined using a variety of histochemical methods to find ways of distinguishing between ante-mortem and post-mortem frostbites. Some animals were treated with ethanol or diazepam. Edema, hyperemia, and incipient accumulation of granulocytes were seen to develop within the 2-6 h for which the animals had survived in the cold (-20 degrees C). The granulocytes were first seen in the capillaries beneath the epithelial papillae and thereafter deeper in the dermis. They mostly accumulated inside the venules in the endothelium, but there were cases in which emigration had started. The best method for demonstrating the reaction appeared to be the alkaline phosphatase reaction, which is strong in guinea pig granulocytes and highlighted the latter well against a negative background. The conclusion is that it is possible to detect a positive vital reaction, but methodologic investigations are needed before similar changes can be visualized in cases of acute hypothermia in human beings.

Acclimatization↗
PubMed1976

Intra-arterial sympathetic blockade in the treatment of clinical frostbite.

Regional medical sympathectomy achieved by the intra-arterial injection of reserpine appeared to be of benefit in the treatment of five patients with acute or chronic frostbite injuries. Clinical improvement was associated with a significant increase in arteriographically determined regional perfusion.

Adult↗
PubMed1990

Experimental frostbite: freezing times, rewarming times, and lowest temperatures of pig skin exposed to chilled air.

Frostbite was produced in the skin of five Hanford Miniature Swine by exposing local areas to chilled air (-75 degrees C) for 1, 3, 5, 10, or 20 min. A copper-constantan thermocouple was inserted into the dermis to measure the temperature. The mean freezing time (the time required to reach 0 degrees C) was approximately 1.9 min. The mean lowest temperatures were 8.8, -15.7, -20.9, -22.5, and -23.4 degrees C for the 1-, 3-, 5-, 10-, and 20-min freezes, respectively. The mean times to rewarm the skin to 25 degrees C were 3.1, 4.5, 5.5, 7.0, and 8.6 min for the 1-, 3-, 5-, 10-, and 20-min freezes, respectively. Significant linear correlations existed between duration of freeze and rewarming times, duration of freeze and lowest temperature, and lowest temperature and rewarming times.

Animals↗
PubMed1996

Frostbite of the face after recreational misuse of nitrous oxide.

Exposure of the skin to nitrous oxide, a liquified gas stored under pressure in a cylinder, can occur in anaesthesiologists and in those involved in recreational misuse of the gas. A case is reported of a man who presented to the emergency department after sniffing nitrous oxide and sustaining frostbite injury to his left cheek. Conservative management of this injury allowed spontaneous separation of the necrotic tissue and healing of the granulating wound by contraction.

Facial Injuries↗
PubMed1991

New horizons in management of hypothermia and frostbite injury.

Diagnosing hypothermia requires a high index of suspicion. Restoring lost heat with careful attention to hemodynamics usually results in complete recovery. Frostbite is best treated by physicians who are cognizant of the pathophysiology of cold injury. Although alternative methods of intervention are being tested, rapid rewarming and anti-inflammatory agents are integral to treatment protocols.

Accidents↗
PubMed1999

Upper aerodigestive tract frostbite complicating volatile substance abuse.

Volatile substance abuse has become increasingly popular among today's youth. It has reportedly been used by up to 13% of teenage populations. Physicians need to be aware of the potential complications which may arise from this form of substance abuse. We describe the case of a young male who presented with massive edema affecting his lips, oral cavity, oropharynx and trachea. It was later discovered that his injury was secondary to thermal trauma related to the abuse of a fluorinated hydrocarbon propellant. This presentation may easily be confused with allergic or angioneurotic edema. Denial by the patient can lead to a further delay in diagnosis. This case is especially notable since frostbite injury involving the upper aerodigestive tract is extremely rare. We discuss the differential diagnosis and the management principals required in the care of this patient. We also present a pertinent review of the literature related to both volatile substance abuse and its complications involving the airway.

Administration, Inhalation↗
PubMed1999

Effect of alpha-trinositol on interstitial fluid pressure, oedema generation and albumin extravasation in experimental frostbite in the rat.

1. The anti-inflammatory effect of alpha-trinositol (D-myo-inositol-1,2,6-trisphosphate) on oedema formation, microvascular protein leakage and interstitial fluid pressure (Pif) in rat skin after frostbite injury, was investigated. Alpha-trinositol (40 mg kg body weight(-1)) was administered intravenously as a bolus both before and/or in the interval between freezing and thawing of the tissue. 2. Pif was measured in rat paw skin with micropipettes connected to a servo-controlled counterpressure system. Oedema formation was estimated by measuring the increase in total tissue water content (wet weight minus dry weight divided by dry weight). Albumin extravasation (i.e., the difference between the plasma equivalent space for 125I- and 131I-human serum albumin (HSA) circulating for different time intervals) was used to estimate the microvascular leakage. 3. Compared to untreated animals, alpha-trinositol given pre- and/or post-freeze reduced total tissue water and albumin extravasation as well as the fall in Pif in injured tissue significantly (P<0.05). Alpha-trinositol given only post-freeze reduced total tissue water and albumin extravasation from 4.46+/-0.93 and 2.37+/-1.12 to 2.51+/-0.29 and 0.36+/-0.18 ml g dry weight(-1), respectively (P<0.05). 4. Pif fell from -0.8+/-0.2 mmHg pre-freeze to -3.4+/-1.0 mmHg (P<0.05) at 20 min after tissue injury (circulatory arrest) and was attenuated by treatment with alpha-trinositol. 5. We conclude that alpha-trinositol exerts its anti-oedematous effect by acting on the extracellular matrix, attenuating the lowering of Pif as well as on the microvascular wall, thereby decreasing the protein extravasation.

Animals↗
PubMed2002

Effects of haemodilution and rewarming with regard to digital amputation in frostbite injury: an experimental study in the rabbit.

Peripheral vascular failure with haematological and haemodynamic changes occurs after frostbite injuries. In order to study the effects of normovolemic haemodilution on the extent of digital necrosis, the paws of rabbits were haemodiluted and frozen to -15 degrees C. Dextran or gelatin was used as the plasma substitute in two groups and the rewarming after the cold injury was performed either at room temperature (22 degrees C) or with hot water baths (38 degrees C). The extent of necrosis was significantly less in the rabbits haemodiluted with dextran or gelatin and rewarmed in hot water baths.

Amputation, Surgical↗
PubMed1990

Frostbite. Methods to minimize tissue loss.

If frostbite is to be treated successfully, direct and indirect effects of injury must be understood. Rapid rewarming helps to preserve tissue by limiting the amount of direct cellular injury. Selective management of blisters helps protect the subdermal plexus, and application of Aloe vera cream (eg, Dermaide Aloe Cream) combats the local vasoconstrictive effects of thromboxane. Oral administration of ibuprofen decreases systemic levels of thromboxane.

Aloe↗
PubMed1999

Oral frostbite injury from intentional abuse of a fluorinated hydrocarbon.

BACKGROUND: A serious but rarely reported complication of halogenated hydrocarbon inhalation abuse is severe mucosal frostbite. CASE REPORT: A 16-year-old male attempted to "get high" by inhaling airbrush propellant which contained 1,1-difluoroethane (CAS #75-376). The patient lost consciousness and upon awakening his lips and tongue were frozen. He suffered first- and second-degree burns of the larynx with vocal cord involvement and first-degree burns of the trachea, main stem bronchi, and esophagus. The oral cavity had second- and third-degree burns which required debridement. CONCLUSION: This case demonstrates the unusual but severe damage that can occur with the abuse of fluorinated hydrocarbons.

Adolescent↗