Frostbite: Review and Current Concepts

Abstract

Background: A literature review was conducted to analyze developments in the epidemiology, pathogenesis, treatment, and prevention of frostbite injury. Increased participation in outdoor activities, as well as the epidemic of homelessness, makes knowledge of the treatment of frostbite crucial for physicians in both rural and urban areas.Methods: A literature search, using the key words "frostbite" and "cold," was done using MEDUNE and Index Medicos. This search focused on the epidemiology, pathogenesis, treatment, and prevention of frostbite.Results: Research done during the past 15 years has clarified the pathogenesis of frostbite injury and led to a better understanding of how to limit tissue loss. The etiology of frostbite is commonly related to alcohol use, psychiatric illness, or motor vehicle problems. The pathogenesis is linked to tissue freezing, hypoxia, and the release of inflammatory mediators. The initial clinical manifestations of frostbite injury are similar for superficial and deep tissue damage, so early treatment is identical for all injuries. Optimum therapy is based on the rapid reversal of tissue freezing by rewarming in 1 04-108°F water and the institution of oral and topical antiprostaglandin therapy to limit the release of inflammatory mediators.

Association Between Components of Body Composition and Scoliosis: A Prospective Cohort Study Reporting Differences Identifiable Before the Onset of Scoliosis

“…(1) Scoliosis is usually idiopathic but 15% to 20% (2) are secondary to various conditions including inherited neurological or musculoskeletal disorders. (3) Idiopathic scoliosis is classified based on age: infantile has an onset before 3 years of age; juvenile between age 3 and 10 years; and adolescent has an onset between age 10 years and skeletal maturity. (4) The adolescent idiopathic scoliosis (AIS) form accounts for the majority of cases of idiopathic scoliosis, and its incidence appears to be increasing for unknown reasons.…”

Thermal Injuries in Veterinary Forensic Pathology

“…The 2-grade system distinguishes a superficial local cold injury involving skin and subcutaneous tissue, whereas deep local cold injury also involves muscles, tendons, and bones. 52,62 The second system classifies local cold injury clinically into 4 degrees, as follows. 62 First-degree frostbite (congelatio erythematosa) includes numbness of the affected skin area with a central white plaque.…”

“…52,62 The second system classifies local cold injury clinically into 4 degrees, as follows. 62 First-degree frostbite (congelatio erythematosa) includes numbness of the affected skin area with a central white plaque. After rewarming, swelling, erythema, and pain develop.…”

Frostbite: Spectrum of Imaging Findings and Guidelines for Management

“…The body initially responds to tissue freezing with alternating cycles of vasodilation and vasoconstriction (the "hunting reaction"), which lead to cycles of partial thawing and a prothrombotic microenvironment (4,5,12). During the vascular stasis phase, local vasoconstriction persists, and hypoxia and acidosis damage the endothelium and promote coagulation and interstitial edema (7,11). Finally, hypoxia, endothelial injury, and local thrombosis lead to the late ischemic phase, in which inflammatory mediators such as prostaglandins, thromboxanes, bradykinins, and histamine trigger additional vasoconstriction, platelet aggregation, and vessel thrombosis (7,11,12).…”

“…During the vascular stasis phase, local vasoconstriction persists, and hypoxia and acidosis damage the endothelium and promote coagulation and interstitial edema (7,11). Finally, hypoxia, endothelial injury, and local thrombosis lead to the late ischemic phase, in which inflammatory mediators such as prostaglandins, thromboxanes, bradykinins, and histamine trigger additional vasoconstriction, platelet aggregation, and vessel thrombosis (7,11,12). Because these inflammatory mediators peak during rewarming, cycles of refreezing and rewarming can worsen the extent of tissue loss (4,7,11).…”