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Frostbite of The Extremities – Recognition, Evaluation and Treatment

  • Jonathan Persitz
    Correspondence
    Corresponding author.
    Affiliations
    Hand and Upper Extremity Surgery Unit, Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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  • Ahmad Essa
    Affiliations
    Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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  • Eran Beit Ner
    Affiliations
    Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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  • Eran Assaraf
    Affiliations
    Hand and Upper Extremity Surgery Unit, Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    Search for articles by this author
  • Erez Avisar
    Affiliations
    Hand and Upper Extremity Surgery Unit, Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zerifin, Israel, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    Search for articles by this author

      Abstract

      Objectives

      Frostbite refers to the freezing of body tissue which is caused by prolonged exposure to cold temperatures and results in tissue destruction. Tissue damage is due to both immediate cold-induced cell death and the more gradual development of localized inflammatory processes and tissue ischemia. A detailed treatment plan based on the current UpToDate literature is needed to decrease morbidity and mortality rates.

      Methods

      The United States National Library of Medicine (PubMed/Medline), EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews were systematically searched to identify publications relevant to this review.

      Conclusion

      In this review, we present the current knowledge on the diagnosis and treatment of frostbite injuries. We then provide an extended and detailed treatment plan, from first aid in the field to treatment of short and long-term complications .

      Keywords

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      References

        • Handford C.
        • Buxton P.
        • Russell K.
        Frostbite: a practical approach to hospital management.
        Extrem Physiol Med. 2014; 3: 7
        • Murphy J.V.
        • Banwell P.E.
        • Roberts A.H.
        Frostbite: pathogenesis and treatment.
        J Trauma. 2000; 48: 171-178
        • Ervasti O.
        • Juopperi K.
        • Kettunen P.
        The occurrence of frostbite and its risk factors in young men.
        Int J Circumpolar Health. 2004; 63: 71-80
        • DeGroot D.W.
        • Castellani J.W.
        • Williams J.O.
        Epidemiology of U.S. Army cold weather injuries, 1980-1999.
        Aviat Space Environ Med. 2003; 74: 564-570
        • Biem J.
        • Koehncke N.
        • Classen D.
        Out of the cold: management of hypothermia and frostbite.
        CMAJ. 2003; 168: 305-311
        • McIntosh S.E.
        • Freer L.
        • Grissom C.K.
        Wilderness medical society clinical practice guidelines for the prevention and treatment of frostbite: 2019 update.
        Wilderness Environ Med. 2019; 30: S19-S32
        • Drinane J.
        • Kotamarti V.S.
        • O'Connor C.
        • Nair L.
        • Divanyan A.
        • Roth M.Z.
        • et al.
        Thrombolytic salvage of threatened frostbitten extremities and digits: a systematic review.
        J Burn Care Res. 2019; 40: 541-549
        • Paine R.E.
        • Turner E.N.
        • Kloda D.
        • Falank C.
        • Chung B.
        • Carter D.W
        Protocoled thrombolytic therapy for frostbite improves phalangeal salvage rates.
        Burns Trauma. 2020; 8 (tkaa008)https://doi.org/10.1093/burnst/tkaa008
        • Petrone P.
        • Kuncir E.J.
        • Asensio J.A.
        Surgical management and strategies in the treatment of hypothermia and cold injury.
        Emerg Med Clin North Am. 2003; 21: 1165-1178https://doi.org/10.1016/s0733-8627(03)00074-9
        • Carceller A.
        • Javierre C.
        • Ríos M.
        • Viscor G.
        Amputation risk factors in severely frostbitten patients.
        Int J Environ Res Public Health. 2019; 16: 1351https://doi.org/10.3390/ijerph16081351
        • Schoenfeld J.
        • Koren C.
        • Shapira Y
        [Cold injuries. I. Physiology and pathology of exposition to cold].
        Harefuah. 1976; 90: 124-128
        • Hall A.
        • Sexton J.
        • Lynch B.
        Frostbite and immersion foot care.
        Mil Med. 2018; 183: 168-171
        • Basit H.
        • Wallen T.J.
        • Dudley C.
        Frostbite. Statpearls.
        Treasure Island (FL): StatPearls Publishing, 2020
        • Shenaq D.S.
        • Beederman M.
        • O'Connor A
        Urban frostbite: strategies for limb salvage.
        J Burn Care Res. 2019; 40: 613-619
        • Joshi K.
        • Goyary D.
        • Mazumder B.
        • Chattopadhyay P.
        • Chakraborty R.
        • Bhutia Y.D.
        • et al.
        Frostbite: current status and advancements in therapeutics.
        J Therm Biol. 2020; 93102716https://doi.org/10.1016/j.jtherbio.2020.102716
        • Heil K.
        • Thomas R.
        • Robertson G.
        Freezing and non-freezing cold weather injuries: a systematic review.
        Br Med Bull. 2016; 117: 79-93
        • Mohr W.J.
        • Jenabzadeh K.
        • Ahrenholz D.H.
        Cold injury.
        Hand Clin. 2009; 25: 481-496
        • Dana A.S.
        • Rex I.H.
        • Samitz M.H.
        The hunting reaction.
        Arch Dermatol. 1969; 99: 441-450
        • Su C.W.
        • Lohman R.
        • Gottlieb L.J.
        Frostbite of the upper extremity.
        Hand Clin. 2000; 16: 235-247
        • Hallam M.-.J.
        • Cubison T.
        • Dheansa B.
        Managing frostbite.
        BMJ. 2010; 341: c5864
        • Zacarian S.
        • Stone D.
        • Clater M.
        Effects of cryogenic temperatures on microcirculation in the golden hamster cheek pouch.
        Cryobiology. 1970; 7: 27-39
        • Melamed E.
        • Glassberg E
        [Non-freezing cold injury in soldiers].
        Harefuah. 2002; 141: 1090
      1. Mills W J.CLINICAL ASPECTS of freezing cold injury. Medical Aspects of Harsh Environments.

        • Hutchison R.L.
        Frostbite of the hand.
        J Hand Surg Am. 2014; 39: 1863-1868
        • Zafren K.
        Frostbite: prevention and initial management.
        High Alt Med Biol. 2013; 14 (a): 9-12https://doi.org/10.1089/ham.2012.1114
        • Bhatnagar A.
        • Sarker B.
        • Sawroop K.
        Diagnosis, characterisation and evaluation of treatment response of frostbite using pertechnetate scintigraphy: a prospective study.
        Eur J Nucl Med. 2002; 29: 170-175
        • Cauchy E.
        • Marsigny B.
        • Allamel G.
        The value of technetium 99 scintigraphy in the prognosis of amputation in severe frostbite injuries of the extremities: a retrospective study of 92 severe frostbite injuries.
        J Hand Surg Am. 2000; 25: 969-978
        • Greenwald D.
        • Cooper B.
        • Gottlieb L
        An algorithm for early aggressive treatment of frostbite with limb salvage directed by triple-phase scanning.
        Plast Reconstr Surg. 1998; 102: 1069-1074
        • Barker J.R.
        • Haws M.J.
        • Brown R.E.
        Magnetic resonance imaging of severe frostbite injuries.
        Ann Plast Surg. 1997; 38: 275-279
        • Bruen K.J.
        • Ballard J.R.
        • Morris S.E.
        • Cochran A.
        • Edelman L.S.
        • Saffle J.R.
        Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy.
        Arch Surg. 2007; 142: 546-553https://doi.org/10.1001/archsurg.142.6.546
        • Lehmuskallio E.
        • Lindholm H.
        • Koskenvuo K.
        Frostbite of the face and ears: epidemiological study of risk factors in Finnish conscripts.
        BMJ. 1995; 311: 1661-1663
        • Nygaard R.M.
        • Lacey A.M.
        • Lemere A.
        • Dole M.
        • Gayken J.R.
        • Wagner A.L.L.
        • et al.
        Time matters in severe frostbite: assessement of limb/digit salavage on the individual patient level.
        J Burn Care Res. 2017; 38: 53-59
        • Twomey J.A.
        • Peltier G.L.
        • Zera R.T.
        An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite.
        J Trauma. 2005; 59: 1350-1355https://doi.org/10.1097/01.ta.0000195517.50778.2e
        • Sheridan R.L.
        • Goldstein M.A.
        • Stoddard F.J.
        • Walker T.G.
        Case records of the Massachusetts general hospital. Case 41-2009. A 16-year-old boy with hypothermia and frostbite.
        N Engl J Med. 2009; 361: 2654-2662
        • Saemi A.M.
        • Johnson J.M.
        • Morris C.S.
        Treatment of bilateral hand frostbite using transcatheter arterial thrombolysis after papaverine infusion.
        Cardiovasc Intervent Radiol. 2009; 32: 1280-1283
        • Cauchy E.
        • Cheguillaume B.
        • Chetaille E.
        A controlled trial of a prostacyclin and rt-PA in the treatment of severe frostbite.
        N Engl J Med. 2011; 364: 189-190
        • Woo E.-.K.
        • Lee J.W.
        • Hur G.-.Y.
        Proposed treatment protocol for frostbite: a retrospective analysis of 17 cases based on a 3-year single-institution experience.
        Arch Plast Surg. 2013; 40: 510-516
        • Imray C.H.E.
        • Oakley E.H.N.
        Cold still kills: cold-related illnesses in military practice freezing and non-freezing cold injury.
        J R Army Med Corps. 2006; 152: 218-222
        • Robson M.C.
        • Heggers J.P.
        Evaluation of hand frostbite blister fluid as a clue to pathogenesis.
        J Hand Surg [Am]. 1981; 6: 43-47
        • Callison C.
        • Nguyen H.
        Tetanus prophylaxis.
        ([Updated 2021 Jun 7])StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2022 (Jan-. Available from)
        • Havers F.P.
        • Moro P.L.
        • Hunter P.
        • Hariri S.
        • Bernstein H.
        Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: updated recommendations of the advisory committee on immunization practices - United States, 2019.
        MMWR Morb Mortal Wkly Rep. 2020; 69 (Published 2020 Jan 24): 77-83https://doi.org/10.15585/mmwr.mm6903a5
        • Chan T.Y.
        • Smedley F.H.
        Tetanus complicating frostbite.
        Injury. 1990; 21: 245
        • Reamy B.V.
        Frostbite: review and current concepts.
        J Am Board Fam Pract. 1998; 11: 34-40
        • Heggers J.P.
        • Robson M.C.
        • Manavalen K.
        Experimental and clinical observations on frostbite.
        Ann Emerg Med. 1987; 16: 1056-1062
        • McCauley R.L.
        • Hing D.N.
        • Robson M.C.
        Frostbite injuries: a rational approach based on the pathophysiology.
        J. Trauma. 1983; 23 (143Y7)
        • Shakirov B.M.
        Frostbite injuries and our experience treatment in the Samarkand area Uzbekistan.
        Int J Burns Trauma. 2020; 10: 156-161
        • Robins M.
        • Hendriksen S.
        • Cooper J.S.
        Hyperbaric management of frostbite.
        StatPearls. Treasure Island (FL): StatPearls Publishing, 2020
        • von Heimburg D.
        • Noah E.M.
        Sieckmann UP. Hyperbaric oxygen treatment in deep frostbite of both hands in a boy.
        Burns. 2001; 27: 404-408
        • Kemper T.C.P.M.
        • de Jong V.M.
        • Anema H.A.
        Frostbite of both first digits of the foot treated with delayed hyperbaric oxygen:a case report and review of literature.
        Undersea Hyperb Med. 2014; 41: 65-70
        • Buras J.
        Basic mechanisms of hyperbaric oxygen in the treatment of ischemia-reperfusion injury. 38. Int Anesthesiol Clin, 2000: 91-109 (Winter)
        • Purkayastha S.S.
        • Bhaumik G.
        • Chauhan S.K.S.
        Immediate treatment of frostbite using rapid rewarming in tea decoction followed by combined therapy of pentoxifylline, aspirin & vitamin C.
        Indian J Med Res. 2002; 116: 29-34
        • Pasquier M.
        • Ruffinen G.Z.
        • Brugger H.
        Pre-hospital wrist block for digital frostbite injuries.
        High Alt Med Biol. 2012; 13: 65-66
        • Chandran G.J.
        • Chung B.
        • Lalonde J.
        • Lalonde D.H.
        The hyperthermic effect of a distal volar forearm nerve block: a possible treatment of acute digital frostbite injuries?.
        Plast Reconstr Surg. 2010; 126: 946-950https://doi.org/10.1097/PRS.0b013e3181e60400
        • Ali N.M.K.
        • Green L.
        • Buckwalter J.A.
        Effective management of frostbite with sympathetic blockade regional anesthesia: the journal of neural blockade in obstetrics.
        Surgery, & Pain Control. 1982; 7: 128-130
        • Taylor M.S.
        • Kulungowski M.A.
        • Hamelink J.K.
        Frostbite injuries during winter maneuvers: a long-term disability.
        Mil Med. 1989; 154: 411-412
      2. Auerbach P.Wilderness medicine.. 5th ed. London: Elsevier Health Sciences; 2007:195–210.

        • Selke Jr., A.C.
        Destruction of phalangeal epiphyses by frostbite.
        Radiology. 1969; 93: 859-860https://doi.org/10.1148/93.4.859