Management and Outcome of Feet Deep Frostbite Injury (III and IV Degrees): A Series Report of 36 Cases

Abstract

Deep feet frostbite is a severe trauma and often leads to amputation due to full-thickness skin necrosis and subcutaneous tissue damage. A retrospective analysis was performed between June 2013 and June 2019 to review the management measures and outcomes of clinical treatment, and available data had been collected including demographic characteristics, risk factors, and injury environment record. Treatment protocols, wound management, and outcomes were also presented. There were 36 patients diagnosed with deep feet frostbite with a mean age of 51.5 years; the ratio for male to female is 5:1. Drunk and mental disorders were the main risk behaviors for frostbite occurrence. As for the injury environment, mean temperature and wind speed were −20.5 °C and 3.3 m/s, respectively. Fourteen cases achieved wound healing without surgery intervention, 5 cases received skin graft, and 17 cases received amputation. Most amputations (12 cases) were restricted at toe level; only 1 case received whole feet amputation. Our finding indicated that feet deep frostbite in our hospital showed a male predominant and older age including various risk behaviors and coexistence risk factors. Clinical management based on pathology mechanism needs further improvement, as the amputation rate was still high. How to avoid amputation and lower the amputation level are the focus of future efforts.

Frostbite treatment: a systematic review with meta-analyses

“…Treatments are grouped according to the quantification methods. HBOT = Hyperbaric oxygen therapy Outcome quantified by the Hennepin Score (3 studies) a [ 9 , 24 , 31 ] Treatment Cases Tissue salvage rate Treatment including thrombolysis 78 76% Treatment without thrombolysis 45 49% Outcome quantified by the digit salvage rate (10 studies) a [ 8 – 10 , 18 , 23 , 30 , 32 , 48 – 50 ] Treatment Cases Digit salvage rate Treatment including thrombolysis 115 69% Treatment including iloprost + HBOT 28 98% Treatment including iloprost 30 85% Yukon frostbite protocol b 22 80% Treatment without thrombolysis, iloprost or HBOT 35 48% Outcome quantified by the phalanges salvage rate (1 study) [ 26 ] Treatment Cases Phalanges salvage rate Treatment including thrombolysis 5 87% Outcome quantified by the amputation rate (7 studies) [ 29 , 51 …”

Iloprost for the treatment of frostbite: a scoping review

“…Alprostadil, also known as prostaglandin E 1 , is another prostaglandin used in frostbite for its vasodilating properties, but the experience is limited to Korea, the United States and China [ 33–35 ]. It has been used as an intravenous infusion for 24 h along with NSAIDs [ 33 ] or as an adjunct to thrombolysis, injected intra-arterial prior to thrombolytic administration to dilate the spasmodic microvessels [ 34 , 35 ].…”

Autumn’s Golden Leaves

“…Onoyama et al 15 have identified the importance of psychological issues in terms of ulcer development among patients with peripheral arterial disease. Tang et al 16 have documented the efficacy of debridement followed by topical polymyxin B ointment for the management of chronic recalcitrant ulcers.The issue is completed by interesting case presentations [17][18][19] and letters. We are confident that readers will appreciate the scientific content.…”

“…The issue is completed by interesting case presentations [17][18][19] and letters. We are confident that readers will appreciate the scientific content.…”