Analysis of Frostbite (1)

ABSTRACT

PURPOSE: Frostbite can affect people involved in winter sports, homeless and soldiers. It results in tissue necrosis from direct cellular damage and indirect damage secondary to vasospasm and the progressive microvascular thrombosis following reperfusion of the ischemic limb. However, the frostbite is under-estimated by the physicians. We describe the assessment and management of frostbite and identify the challenges of managing these complex tissue injuries. METHODS: A retrospective analysis of 62 injuries (61 men, average age; 20.5 yo) was conducted between August 2009 to April 2011 in the burn center of AFCH. We sought to determine the demographic characteristics, identification of soft tissue injury, treatment and complications. RESULTS: The 62 were treated as outpatients (n=23, 37.1%) or inpatients (n=39, 62.9%). The superficial degree was 38 (61.3%), while 24 (38.7) have deep degree. The 47.4% of superficial and 87.5% of deep frostbite were admitted. The sites most prone to frostbite were feet (95.2%), followed by hands (27.4%). The toes had the more deep injuries. The 6 cases (9.7%) occurred in wet circumstances. They had suffered more deep injuries than dry circumstances (66.6% vs 35.8%). Thirteen (33.3%) of inpatients were transferred to center 14 days after exposure. The increased levels of isoenzymes did not present the degree of injuries. The bone scan was performed in 22 (56.4%) of inpatients at average 11.3 PFD. We believe it showed an excellent correlation with clinical course, though not confirmed statistically. The patient was treated with rapid rewarming (7; 11.3%), hydrotherapy (11; 17.7%), STSG (3; 12.5 of deep frostbite), berasil (14; 22.6%) and ibuprofen (5; 8.1%). The PGE1 was administered to 34 (87.2%) of inpatients for 8.8 days. We believe the effect of PGE1 to prevent amputations, though not confirmed in evidence base. The sequelae of 9 (23.1%) inpatients included of paresthesia (10.3%), LOM (10.3%), Raynaud's syndrome (7.7%) and hyperhydrois (2.6%). CONCLUSION: In a military context, health education of troops is necessary to avoid moisture circumstances and to protect from cold injuries. We need new guideline to recommend early rewarming and evacuation to specialized units so that the degree of frostbite can be alleviated and rate of complication can be lowered. We need new principles to use NSAIDs, pentoxifylline, antiprostaglandin agents and thrombolytic therapy in amelioration of tissue damage. Together with initial aids, use of radiological assessment, triple phase bone scanning, Duplex studies, Plethysmograpy and future advancements should allow for a more aggressive and active approach to the management of tissue viability. This information is only a primer and requires continuous updating to improve patient outcomes.