Amputation Risk Factors in Severely Frostbitten Patients

Abstract

In recent years, the incidence of frostbite has increased among healthy young adults who practice winter sports (skiing, mountaineering, ice climbing and technical climbing/alpinism) at both the professional and amateur levels. Moreover, given that the population most frequently affected is healthy and active, frostbite supposes a substantial interruption of their normal activity and in most cases is associated with long-term sequelae. It particularly has a higher impact when the affected person’s daily activities require exposure to cold environments, as either sports practices or work activities in which low temperatures are a constant (ski patrols, mountain guides, avalanche forecasters, workers in the cold chain, etc.). Clinical experience with humans shows a limited reversibility of injuries via potential tissue regeneration, which can be fostered with optimal medical management. Data were collected from 92 frostbitten patients in order to evaluate factors that represent a risk of amputation after severe frostbite. Mountain range, years of expertise in winter mountaineering, time elapsed before rewarming and especially altitude were the most important factors for a poor prognosis.

The classification of freezing cold injuries - a NATO research task group position paper

“…Injured tissue could, to some extent, be saved with advanced hospital care, although the level and duration of the in-freeze situation, among other factors is decisive [ 38 , 39 , 43 ]. Surgical amputation decisions are determined in part by altitude as the most relevant amputation risk factor derived from a stepwise regression model [ 44 ]. The Yukon Frostbite Protocol relies on the Cauchy system of frostbite grading to determine treatment [ 39 ].…”

“…The waiting period (weeks or months), necessary to determine the amputation level, is likely to cause mental anguish for the patient. FCI symptoms such as numbness and coldness of the injured part have been regarded as secondary clinical signs and symptoms, after vasoconstriction and ischaemia, because they are usually of little help for predicting prognosis before rewarming [ 44 ].…”

“…The majority of FCIs with an amputation outcome most often occur at air temperatures below −20°C [ 39 ]. Altitude induces a temperature drop of approximately 1°C every 150 metres of ascent (about 6.5°C/1000 m) making altitude a relevant risk factor for amputation [ 44 ]. An FCI can also occur in liquid seawater due to a higher human tissue in-freeze temperature, as seawater freezes at−1.9°C [ 23 ].…”

Editorial on the Special Issue on “Mountain Sports Activities: Injuries and Prevention”

“…The hostile environmental conditions at high altitude or when performing mountain sports in the winter are associated with the risk to suffer from frostbite and/or hypothermia, frequently resulting in adverse long-term consequences or even death. Carceller and colleagues evaluated factors related to the risk of amputation in patients who suffered from severe frostbite [ 5 ]. Regression analysis revealed the mountain range, years of expertise in winter mountaineering, time elapsed before rewarming, and especially altitude as the most important factors for a poor prognosis.…”

Practical Review of the Current Management of Frostbite Injuries

“…Frostbite injury, once considered a military phenomenon, has become more common in the civilian population, with increased incidence among homeless individuals, industrial workers, and people engaging in cold weather recreational activities. [1][2][3][4] Although data on the overall incidence of frostbite are limited, a retrospective study of 241 patients reported a 3% mortality rate. In the same study, however, surgical intervention with debridement and/or amputation was required in 20% of patients.…”