These bitterly cold days’ of -20 including the wind-chill our extremities namely hands and feet are at high risk for developing frostbite. The severity of frostbite injury is proportional to the temperature and exposure time. Frostbite, however does covers a wide range of injuries, from minimal tissue damage to substantial tissue necrosis that can result in amputation.
Predisposing Factors (no specific order)
Prolong exposure to cold
African Americans (4 times more likely)
Phases of Frostbite
1. Pre-Freeze phase / 2. Freeze Thaw phase Direct tissue injury occurs with exposure to cold as you can see with the 2nd and 3rd toes there is slight discoloration with swelling this is related to the dehydration of the cells which diffuse the water out and within the toe. Further rewarming also increases edema of the affected area. If left untreated and skin tissue debrided a compartment syndrome may occur further damaging stable cells.
3. Vascular Stasis phase
Freeze causing vasoconstriction of the blood vessels which reduce blood volume and therefore further reduce blood flow. This causes microvascular damage to the cells, which cause edema formation but also microthrombi which blocks further blood to the toes. On the picture to the right notice the 2nd and 5th toes how they are demarcating black. This is early signs of necrosis.
4. Late Ischemic phase
The final phase occurs when tissue starts dividing between the viable and non viable tissue. Throughtout the phase of healing there are specific treatments that must occur address gangrene and infection
Treatment varies depending to severity of injury and the onset of injury. Within 24 hrs of injury specific treatment options can be utilized if safe. These aggressive treatments are performed in a hospital sitting with close monitoring. But if done within 24 hours of injury it can reduced digital amputation rates from 41% to 10%
In the acute phases, rewarming is important but rewarming too quickly will causes more damage. Further use of medication like aspirin will also increase tissue damage. Seeking appropriate and timely treatment is vital.
As the condition of the extremities are changing so does the treatment. Addressing tetanus and oral antibiotics are important to reduce risk of TB and also sepsis.
Ambulation must be limited and use of special shoe to reduce any pressure to the toes must be maintained. The use of imagining has also shown to assess to potential of healing and need of surgery. Discussion with your treating doctor is needed to find out what study you should have.
Surgery? Early surgery to save tissue is an option but again there is a window of opportunity which must be taken advantage of. Use of IV clot busting agents have shown potential to save digits.
Early surgical debridement is contraindicated in almost all patients. It can take weeks for definitive demarcation of non-viable tissues to occur and tissues that initially looked unsalvageable may recover.
Patient get worried and concerned about there toes and want an early treatment. Understandable, but at time tissues with a proper protocol can be salvage.
Long Term Consequences?
Most common encounter of this injury is chronic pain. This pain can be so devastating to a patient that they request an amputation. However, at times that is not enough and complex regional pain syndrome occurs. Freezing injuries may produce localised osteoporosis as well. These changes are thought to be secondary to vascular damage,
In conclusion, prevention is the key to reduce this life changing injury. Seek treatment in your area or feel free to consult us anywhere over the world wide web. Go to our website for details
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