A Tibetan adolescent girl suffered frostbite on the journey of pilgrimage: A case report / 中华创伤杂志(英文版)

Frostbite in Southwestern China has been overlooked due to its low incidence, relatively mild temperature and lack of literature published before. However, it needs to be further studied for religious diversity and distinct geomorphology. In this article, we reported an 18-year-old Tibetan girl who suffered from blizzard attack during pilgrimage. Her feet and several fingers showed mummified gangrene upon physical examination with poor movement. She was diagnosed with 3rd to 4th degree of frostbite. The girl was given oral ibuprofen, debridement and other regular treatment daily, but she was eventually amputated due to insufficient thrombolytic management in primary hospital, delayed informing consent in the referral hospital and ethnic conflict between religion and guidelines. This case enriched the experience of managing complex frostbite in Tibetan population and alarms that efforts should be integrated to protect pilgrims and mountaineers in the Tibetan region.

Immediate treatment of frostbite using rapid rewarming in tea decoction followed by combined therapy of pentoxifylline, aspirin & vitamin C.

BACKGROUND & OBJECTIVES: Frostbite, the severest form of cold injury is a serious medical problem for our Armed Forces operating in the snow bound areas at high altitude. Effects of treatment by rapid rewarming in tea decoction followed by combined therapy of pentoxifylline, aspirin and vitamin C were evaluated in amelioration of tissue damage due to experimentally induced frostbite in rats. METHODS: Experiments were conducted in 2 groups (25 each) of albino rats (control i.e., untreated and experimental i.e., treated). Frostbite was produced experimentally in all the animals by exposing one of the hind limbs at -12 +/- 1 degree C with wind flow 25-30 lit/min for 30 min in a freezing-machine, with simultaneous recordings of rectal and ambient temperatures. The degree of tissue damage was assessed after 10 days. Following cold exposure, neither external thawing nor any medication was given to the animals of the control group; while the exposed limb of the experimental animals was rewarmed in tea decoction maintained at 37-39 degrees C for 30 min immediately after cold exposure, with simultaneous oral ingestion of warm tea decoction. These animals were also given pentoxifylline (40 mg/kg), aspirin (5 mg/kg) and vitamin C (50 mg/kg) twice daily orally for the next 7 days. RESULTS: In the control group, 68 per cent animals suffered from severe (56%) to very severe (12%) frostbite, while the remaining 32 per cent had moderate frostbite. No animals of this group could escape injury or suffered anything less than moderate frostbite; whereas 52 per cent of experimental animals escaped injury (no frostbite) and 32 and 16 per cent suffered only with primary and moderate degree of injury, respectively. None from this group suffered from severe or very severe frostbite. INTERPRETATION & CONCLUSION: It is evident from the study that this combined therapy resulted in significant improvement in the degree of tissue preservation and proved to be highly beneficial as an immediate treatment of frostbite in rats. The combined pharmacological properties of these drugs might have altered the haemorrheologic status of blood and produced curative beneficial effect in improving tissue survival. Clinical studies are required for confirmation of these beneficial effects in humans, which has already been taken up.

Manejo conservador de las lesiones por frío / Conservative management of frost injuries

Desde 1979 a 1993, se han atendido 14 pacientes con congelamiento en las extremidades superiores e inferiores. Los 14 pacientes fueron de sexo masculino, con edades entre 19 y 28 años. Estos 14 pacientesaoprtaron un total de 78 dedos afectados, 50 dedos de los miembros superiores y 28 en los pies. Clínicamente la mayoría fueron congelamiento de 2º. El tratamiento médico comprendió reposo, uso de antiinflamatorios, antiagregantes plaquetarios y vasodilatadores en forma tardía. Las amputaciones de necesidad se efectuaron a los 24 días en los más precoces y a los 60 días en los más tardíos. En su mayoría fueron amputaciones parciales y en 2 casos se amputaron ortejos en forma total. Se realizaron algunos injertos demoepidérmicos y plastía de pulpejos

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.