Microangiography to Monitor Treatment Outcomes Following Severe Frostbite Injury to the Hands

Abstract

Frostbite injury causes direct damage to tissues following exposure to temperatures below their freezing point causing tissue death potentially leading to serious amputations. After rewarming, a variety of treatment options have been employed to avoid amputation. This case report details the use of indocyanine green fluorescence microangiography to monitor the clinical progression of perfusion following hyperbaric oxygen therapy (HBOT) for severe frostbite injury. We present a case report of a man with deep frostbite of the bilateral hands treated with thrombolytics and HBOT. After rewarming, the patient received thrombolytics shortly after arrival and then went on to be treated with HBOT on hospital day 5. Patient's healing progress was monitored using serial microangiography. Microangiography evaluation was performed on day 6 and then weekly to track treatment progress. A more uniform brightness appears in his left hand by completion of his therapies, consistent with normal perfusion. The dark ischemic areas in the right hand receded in digits 1 to 3 and appeared normalized in the fourth digit. The patient received a total of 20 HBO treatments. After completion of therapy, the patient went on to have a partial amputation of his first, second, and third fingers on his right hand. Our case report demonstrates serial microangiography to monitor a frostbite patient's progress during HBOT and provided additional information allowing us to plan duration of treatments. Our case report describes the role that microangiography may serve in monitoring patient progress following severe frostbite injury.

A oxigenoterapia hiperbárica como tratamento complementar na abordagem terapêutica do paciente queimado: uma revisão integrativa

“…Mais estudos são necessários, sendo sugerido que a abordagem multiterapêutica pode ser eficaz no tratamento de queimaduras elétricas nas mãos. (Masters et al, 2018) Este relato de caso detalha o uso de microangiografia de fluorescência verde de indocianina para monitorar a progressão clínica da perfusão após oxigenoterapia hiperbárica (OHB) para lesões graves por congelamento. Apresentado um o caso de um homem com geladura profunda nas mãos bilaterais tratado com trombolíticos e OHB.…”

Reperfusion After Severe Frostbite: First Full-Thickness Necrosis After Initial Successful Thrombolysis

“…2 The most common sites that are affected are fingers, toes, hands, feet, and to a lesser extent nose and ears. 3 Several factors play a role in determining the severity of cold injuries. The most important ones include exposure to cold temperatures, typically starting from À2 C, wind chill factor, and duration of exposure to cold.…”

“…2 The most common sites that are affected are fingers, toes, hands, feet, and to a lesser extent nose and ears. 3…”

Use of fluorescence to visualize response to iloprost treatment for frostbite

“…5 Ambulatory patients who tolerate the first infusion may have subsequent infusions as an outpatient.Intravenous indocyanine green may provide an important means of characterizing patient response to frostbite treatment and optimizing care. 6 Perfusion is assessed visually by the presence or absence of indocyanine green, using a near-infrared light coupled with a monitor. Comparison of the dye's intensity to surrounding tissues allows a subjective assessment of relative perfusion.…”