Long-Term Sequelae of Frostbite—A Scoping Review

Abstract

Frostbite is tissue damage caused by freezing temperatures and constitutes an important cause of morbidity in cold climate zones and high altitude. The direct effects of sub-zero temperatures lead to tissue freezing, electrolyte shifts and pH alterations, microvascular damage, and eventually to cell death. Upon rewarming, inflammatory reperfusion injury and thrombosis may lead to further tissue damage. Several studies and various case reports show that many patients suffer from long-term sequelae such as vasomotor disturbances (associated with susceptibility to refreezing), and neuropathic and nociceptive pain, as well as damage to skeletal structures. There are still many uncertainties regarding the pathophysiology of these sequelae. It has been shown that the transient receptor potential channel (TRP) family plays a role in cold allodynia. Botulinum Toxin type A (BTX-A) injections have been reported to be beneficial in vasomotor and neuropathic disturbances secondary to frostbite. Epidural sympathetic block has been used for short-term treatment of frostbite induced chronic pain. Furthermore, amitriptyline, gabapentinoids, and duloxetine may have some benefits. Frostbite arthritis clinically resembles regular osteoarthritis. In children there is a risk of epiphyseal cartilage damage leading to bone deformities. Despite some promising therapeutic concepts, the scarcity of data on frostbite long-term sequelae in the literature indicates the need of more in-depth studies of this pathology in all its aspects.

Accidental Hypothermia: 2021 Update

“…The Hypothermia Outcome Prediction after Extracorporeal Life Support (HOPE) score—is currently the best available prediction tool and should be used to evaluate whether a hypothermic patient in cardiac arrest is likely to benefit from ECLS rewarming [ 87 , 135 ]. Frostbite injuries that are still frozen should be thawed as soon as circulation and core temperature have been stabilised [ 136 , 137 , 138 ].…”

Practical Review of the Current Management of Frostbite Injuries

“…Frostbite is an injury that occurs when the skin and tissues are exposed to temperatures below their freezing point (approximately –0.53°C). 5 , 10 , 11 This intense cold exposure results in peripheral vasoconstriction with intermittent cycles of vasodilation. Consequently, blood is shunted from distal areas of the body, resulting in tissue freezing of the feet (47%), hands (19%), ears, lips, and nose (3%).…”

“…A scoping review with five different studies reported that 341 of 493 patients (67%) had long-term complications from frostbite injury, including neuropathy, chronic pain, cold hypersensitivity, hyperhidrosis and functional impairment. 10 Management of these long-term complications are challenging; therefore, early use of chronic pain specialists and medications such as amitriptyline, gabapentin, duloxetine, and topical capsaicin are beneficial. 6 , 7 Additionally, surgical and chemical sympathectomies as well as Botox injections have been proven to decrease pain and Raynaud-associated symptoms.…”

Abstracts from The Cold Weather Operations Conference 2021

“…Lacking evidence-based medicine for CWI, experimental and off-label treatments have contributed to an increased interest in the medical community regarding CWI [ 5 ]. Long-term frostbite sequelae previously lacked treatment options, but new knowledge-based achievements have been presented [ 6 ]. Modern diagnostic equipment and invasive medication in CWI were presented within the cold weather context [ 7 ].…”