Modern management of patients with frostbite
Background: Frostbite is a local cold injury that may lead to loss of tissue, and result in disability. It is normally a consequence of prolonged exposure of unprotected regions to subzero ambient temperatures, which causes impairment of the microcirculation. In Slovenia, the main risk group f...
Main Authors: | , , , , |
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Format: | Article |
Language: | English |
Published: |
Slovenian Medical Association
2012-10-01
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Series: | Zdravniški Vestnik |
Online Access: | http://vestnik.szd.si/index.php/ZdravVest/article/view/599 |
Summary: | Background: Frostbite is a local cold injury that
may lead to loss of tissue, and result in disability.
It is normally a consequence of prolonged
exposure of unprotected regions to subzero ambient
temperatures, which causes impairment of
the microcirculation. In Slovenia, the main risk
group for frostbite injury are mountain climbers.
Frostbite is classified as either a superficialreversible
injury, or an irreversible deep tissue
injury. Superficial frostbite is managed in out-patient clinics, whereas hospital treatment is required
for deep frostbite. The success of frostbite
management depends a great deal on the field
first aid and emergency medical treatment, as
well as on the subsequent hospital treatment.
The present study reports of the success of a protocol
for hospital treatment of frostbite (Planica
Protocol), comprising the early diagnosis with
three-phase bone scintigraphy (TS), administration
of appropriate medications, particularly iloprost,
and initiation of hyperbaric oxygen treatment
(HBOT).
Patients and methods: A total of 27 mountain
climbers presented with frostbite injury between
2000 and 2010. Of these, 16 suffered superficial
injuries and were treated as outpatients. The
remaining 11 mountaineers (2 females, and 9
males) suffered deep frostbite and were hospitalised.
Frostbite injury was sustained at different
altitudes (range: 2000 to 8848 meters above sea
level) in the toes (n = 9; 82 %) and fingers (n = 2;
18 %). Some climbers (n = 9; 82 %) received field
first aid, and some (n = 9; 82 %) also emergency
medical treatment in the field. On admission to
hospital, patients received the following treatpatient clinics, whereas hospital treatment is required
for deep frostbite. The success of frostbite
management depends a great deal on the field
first aid and emergency medical treatment, as
well as on the subsequent hospital treatment.
The present study reports of the success of a protocol
for hospital treatment of frostbite (Planica
Protocol), comprising the early diagnosis with
three-phase bone scintigraphy (TS), administration
of appropriate medications, particularly iloprost,
and initiation of hyperbaric oxygen treatment
(HBOT).
Patients and methods: A total of 27 mountain
climbers presented with frostbite injury between
2000 and 2010. Of these, 16 suffered superficial
injuries and were treated as outpatients. The
remaining 11 mountaineers (2 females, and 9
males) suffered deep frostbite and were hospitalised.
Frostbite injury was sustained at different
altitudes (range: 2000 to 8848 meters above sea
level) in the toes (n = 9; 82 %) and fingers (n = 2;
18 %). Some climbers (n = 9; 82 %) received field
first aid, and some (n = 9; 82 %) also emergency
medical treatment in the field. On admission to
hospital, patients received the following treatment: early diagnosis with TS (n = 7; 64 %);
pharmaceutcial interventions, including acetylsalicylic
acid, low-molecular weight heparin,
pentoxifylline, antibiotics, iloprost (n = 8; 64 %);
and HBOT (n = 8; 73 %).
Results: Of the 11 climbers with deep frostbite,
tissue loss and amputation was avoided in 6
(55 %). Necrectomy (full amputation) was performed
in 5 climbers (45 %): full-length digit
amputation (n = 2), and part-length (one or two
phalanges) amputations (n = 3). Amputation of
the toes was required in both female climbers.
Conclusions: Timely field first aid and emergency
medical treatment is of paramount importance
for a good outcome of frostbite injury.
Early diagnostics using three-phase bone
scintigraphy (TS) can assess the extent of tissue
damage before final clinical manifestation of
frostbite is fully developed. The Planica Protocol
for the treatment of frostbite injury, comprising
early diagnostics (TS), proper medication (acetylsalicylic
acid, low-molecular weight heparin,
pentoxifylline, antibiotics, iloprost), and HBOT
appears to provide a beneficial outcome of deep
frostbite injury. |
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ISSN: | 1318-0347 1581-0224 |