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PubMed2001

Salvage of avascular bone from frostbite with free tissue transfer.

Traditional management of frostbite injury of the hands and fingers has been to allow demarcation to occur between viable and nonviable tissues, corresponding to the level of amputation required. In this case report, phalangeal length in mummified digits was maintained with free tissue transfer followed by evidence of bony revascularization on bone scan. Rather than waiting for tissue demarcation to occur, the authors propose that consideration be given to debridement of soft tissues in the frostbitten fingers followed by free tissue transfer to salvage length and function in the digital bony skeleton.

Adolescent↗
PubMed1976

Assessment of bone viability by scintiscanning in frostbite injuries.

Radionuclide bone imaging with a radiotechnetium-labeled phosphate (99mTc-methylene diphosphonate) has been employed to study the extremities injured by frostbite. The degree of accretion of the radiopharmaceutical in bone is dependent on the integrity of the vascular supply. This property has been used successfully to distinguish viable and nonviable bone.

Adult↗
PubMed1978

Doppler ultrasound and digital plethysmography to determine the need for sympathetic blockade after frostbite.

Thirty patients seen following frostbite injury during a 2-week period were treated with rapid rewarming in a saline bath. Vascular laboratory evaluations including digital plethysmograms and Doppler ultrasound mapping of digital vessels and distal palmar and pedal arches revealed three general degrees of vascular response to cold injury after rewarming. The most common, the hyperdynamic response, implying patent digital vessels, was often clinically apparent, with warm, red digits. Regional sympathectomy may be troublesome in these patients. Patients without a hyperdynamic response, including those whose Doppler and plethysmographic examinations were within normal limits for noncold exposed individuals, had evidence of vascular compromise at the digital level and benefited from regional sympathectomy with intra-arterial reserpine.

Doppler Effect↗
PubMed1997

Frostbite injuries of the hand.

Frostbite may be defined as acute freezing of tissues as a result of exposure to temperatures below the freezing point of intact skin. Severity of injury is due to the degree of cold and the duration of exposure. Tissue injury occurs during freezing due to the actual formation of ice crystals within the extracellular fluid. In addition, ice crystals form in the blood and lead to sludging and cessation of capillary blood flow. However, the most severe tissue damage comes with rewarming the tissues. Reperfused capillaries, with their damaged endothelium, leak fluid and protein leading to edema. Blisters form, and prostaglandins and thromboxanes in the blister fluid cause platelet aggregation. Rapid rewarming of the part is now the acceptable practice. Immersion of the injured part in a whirlpool bath is recommended at a temperature of 100 to 108 degrees Fahrenheit. Eventual care may include debridement and tissue transfers if amputation is required. A case is presented of a woman with frostbitten hands.

Adult↗
PubMed1989

Morphologic characterization of acute injury to vascular endothelium of skin after frostbite.

Cyclo-oxygenase inhibitors and free-radical scavengers protect the skin against necrosis induced by frostbite. However, the tissue component(s) that determine the evolution of skin necrosis and the mechanism of this pharmacologic protection are not precisely defined. We have studied freezing injury to rabbit ears by serial biopsies examined by light and electron microscopy. The morphologic evidence of skin injury due to freezing was localized exclusively in the endothelial cells, particularly in the arterioles. Within 1 hour, the entire microvasculature demonstrated endothelial damage. Intravascular platelet aggregation occurred just after thawing and closely paralleled the endothelial cell injury. Very few neutrophils were seen initially (at 10 minutes). By 1 hour, leukocyte aggregates were present, and they further increased at 6 hours. Swelling of the interstitium started 10 minutes after thawing, while extravasation of erythrocytes began to appear by 6 hours. Parenchymal elements of skin were relatively free of damage. In the ear cartilage, the chondrocytes showed evidence of damage immediately after freezing. The administration of superoxide dismutase (SOD) during thawing (reperfusion) did not qualitatively alter any of the initial morphologic changes induced by freezing. We conclude that the endothelial cell is the initial target of injury induced by freezing, an initial injury that is mediated by a non-free-radical-mediated mechanism. It is likely that this acute injury ultimately compromises blood flow and leads to skin necrosis.

Animals↗
PubMed1993

Frostbite in the prairies: a 12-year review.

A 12-year retrospective review of inpatient frostbite injury was undertaken in three tertiary hospitals serving a northern prairie population of 650,000. In the 125 patients identified, the mean age was 41 years, with a range of 3 to 90 years. Predisposing factors were alcohol consumption (46 percent), psychiatric illness (17 percent), vehicular trauma (19 percent), vehicular failure (15 percent), and drug use (4 percent). Profound hypothermia with a core temperature less than 32 degrees C was present in 12 percent. Anatomic distribution was 19 percent upper extremity, 47 percent lower extremity, 31 percent combined upper and lower extremity, and 3 percent facial or trunk only. Factors correlating with amputation of parts (p < 0.05) were duration of exposure, lack of proper attire, remote site of injury, presence of wound infection, and delay in seeking treatment. Prophylactic systemic antibiotics did not decrease the incidence of wound infection. Comparison with nine other civilian series revealed striking similarities in the patient populations.

Adolescent↗
PubMed2000

Free flap coverage of bilateral frostbite of the feet.

The indications, principles of management, and outcomes of free flap transfer for limb salvage in four patients with bilateral frostbite of their feet are presented. A fasciocutaneous flap was used for coverage when the wound involved a single surface of the foot. When multiple surfaces of the foot required free flap coverage, a muscle flap was used because it could more easily improve the shape and contour of the defect. Successful coverage was achieved in all four patients.

Adolescent↗
PubMed2000

Frozen chips: an unusual cause of severe frostbite injury.

A case of severe frostbite injury to the right foot is presented. This was caused by the inappropriate application of a bag of frozen chips to the foot in an attempt to ease non-specific pain. No specific acute traumatic injury was identified. As the patient was a teacher of physical education, the pain had initially been assumed to originate from a minor musculoskeletal injury. Full recovery ensued after surgical excision of necrotic tissue and split skin grafting. The danger of inappropriate overenthusiastic use of ice packs or other frozen material to treat soft tissue injuries is emphasised. The need for education to prevent similar future injuries is discussed.

Adult↗
PubMed1986

A case of frostbite or "it takes more than two pairs of socks to keep your feet warm".

During February 1985 a squadron of an engineer regiment deployed into the field to exercise its men in basic infantry skills. One of these men was a 20 year old sapper. During the exercise he sustained frostbite injury to both feet, the right foot being more affected than the left. The background, clinical progress and preventive medicine implications are discussed.

Adult↗
PubMed1987

Treatment of frostbite with i.v. streptokinase: an experimental study in rabbits.

Experiments were conducted in 32 rabbits to determine whether treatment with IV streptokinase can effectively limit the extent of tissue damage associated with frostbite injury of the hind limbs. Other variables studied were the temperature of the tissue during freezing, the time taken to rewarm the exposed limbs, and the delay between the initiation of treatment with streptokinase and cessation of freezing. A control group of 16 rabbits was not given streptokinase. The extent of tissue damage was estimated by sequential radionuclide perfusion scans of the exposed limbs. This estimate was based on the proportional loss of tissue perfusion on subsequent twice-weekly nuclear scans in comparison with that shown by scans performed immediately after thawing. Pathologic changes in exposed tissues were studied by histology. Streptokinase treatment and rapid rewarming both resulted in less tissue damage at all freezing temperatures. Streptokinase was most beneficial when given 12 hr after freezing, but was effective even when treatment was delayed up to 48 hr.

Animals↗
PubMed1997

[The adaptive changes in vascular endothelial cell and resistance to frostbite in cold acclimated rats].

Several functions of vascular endothelial cells (VEC) were investigated in rats acclimated to cold (CA) and with frostbitten feet. The results indicated that in CA rats, the number of endothelial cells in circulatory blood and the contents of 6-keto -PGF1 alpha and TXB2 in plasma were markedly higher, the activity of serum angiotensin I converting enzyme (ACE) was lower, compared with those in rats non-acclimated to cold (NCA), whereas T/P ratio of the two groups was close to each other. After the rats were frostbitten, those parameters in NCA group increased sharply except for a decrease in ACE activity. But in CA group, those parameters decreased temporarily or did not change obviously and the tissue survival area (TSA) significantly increased. The above findings suggest that the adaptive changes in increase of metabolic turnover rate and function of VEC after cold acclimation may be beneficial to the body to enhance the resistance to frostbite and repairing ability.

6-Ketoprostaglandin F1 alpha↗
PubMed2002

Delayed treatment of frostbite injury with hyperbaric oxygen therapy: a case report.

The effects of hyperbaric oxygen therapy on skin microcirculation were evaluated by laser-Doppler flowmetry and vital capillary microscopy in a frostbite victim 2 wk after the injury. Laser-Doppler skin blood flow, measured in intact skin on the dorsum of the foot, decreased from 52 to 31 perfusion units during hyperbaric oxygen therapy. The number of visible nutritive capillaries in frostbitten areas on the toes increased from 2 to 12 per mm2, as measured immediately after the hyperbaric oxygen therapy. We conclude that hyperbaric oxygen therapy is capable of improving nutritive skin blood flow in frostbitten areas more than 2 wk after the injury.

Adult↗
PubMed2002

[Serious frostbite in a homeless psychiatric patient].

A 22-year-old homeless male psychiatric patient of Ghanaian origin was diagnosed with severe frostbite in both lower legs. The lesion consisted of haemorrhagic blistering with already visible demarcation. When sepsis developed both lower legs had to be amputated as a matter of urgency.

Adult↗
PubMed2003

Effect of cold acclimation on hemorheological behavior in rats with frostbite.

The hemorheological behavior pre- and post-freezing and tissue survival area (TSA) of frostbitten hind feet in cold-acclimated rats (group CA) and the control (group C) were observed in order to go further into the mechanism of cold acclimation. The results indicated that blood viscosity and RBC aggregation tendency were lowered and RBC deformability improved obviously in CA rats as compared with those in group C (p<0.01). After the rats' hind feet were frozen, the hemorheological behavior in both group CA and C rats was changed abnormally and the changes were less serious in CA rats than those in C rats. The TSA of CA rats was much larger than that of C rats (p<0.01). The aforesaid results revealed that after rats were acclimated to cold, their resistance to freezing increased and their adaptive changes in hemorheological behavior occurred. The extent of abnormal changes in hemorheological behavior caused by freezing was reduced in CA rats, therefore the disorder microcirculation could be improved. These changes were beneficial to the frostbitten tissue to recovering and healing. So it is considered that in CA rats, the adaptive change in hemorheological behavior is one of the cause enhancing resistance to frostbite.

Acclimatization↗
PubMed1992

[Microwave therapy of frostbite of the extremities].

In the experiment, frostbite of the hind legs in rabbits was induced for 3 hours. The extremities of 12 animals of the experimental group were influenced with UHF-field with a wavelength of 12.6 cm of nonthermal intensity (3 W) for 10 minutes one time after termination of cold influence. The extremities of 18 rabbits of the control group were warmed in a natural way. The milder course of cold trauma in animals of the experimental group manifesting itself in higher temperature of a skin of the damaged extremity, more rapid disappearance of edema and lesser spreading of cyanosis, tissue necrosis of an extremity--(7.6 +/- 2.5) and (11.7 +/- 1.2) cm, respectively--was noted. The authors consider that microwave therapy can be included into the complex of measures at the early period of treatment of local cold trauma.

Animals↗