The utility of bone scintigraphy with SPECT/CT in the evaluation and management of frostbite injuries

Manganaro, Matthew S.; Millet, John D.; Brown, Richard K.; Viglianti, Benjamin L.; Wale, Daniel J.; Wong, Ka Kit

doi:10.1259/bjr.20180545

Cited by 17 publications

(33 citation statements)

References 47 publications

(86 reference statements)

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“… 8 , 34 , 42 Today, bone scans and SPECT/CT can measure the extent of damage within the first week of injury. 25 , 34 , 43 Therefore, the current literature recommends delayed surgery (2-–4 weeks after injury) with soft tissue debridement and bone scan-guided amputations. 37 , 39 , 40 To restore previous form and function after delayed surgery, dermal tissue grafts, local flaps and free flaps can be utilized.…”

Section: Resultsmentioning

confidence: 99%

Practical Review of the Current Management of Frostbite Injuries

Zaramo

Green

Janis

2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Frostbite is an injury that occurs when the skin and tissues are exposed to temperatures below their freezing point. This type of injury can lead to various complications such as functional loss, chronic pain, and psychological trauma. As such, understanding frostbite management is crucial for optimal patient care. A scoping review was conducted in February 2022 using PubMed, EMBASE, referenced articles and snowballing to identify relevant published articled using the terms “frostbite” and “management” and “surgery. Articles related to pathophysiology, classifications, radiography, complications, and medical and surgical management were included to formulate recommendations for practical management. Two hundred fifty-one articles were identified and 54 met inclusion criteria. Rapid rewarming in warm water (40-42 °C) remains the standard of care. Thrombolytic therapy has been shown in numerous studies to improve tissue salvage. Radiographic imaging has become crucial in the evaluation and management in frostbite injury. Current literature recommends delayed surgery with soft tissue debridement and bone scan-guided amputations. Surgical intervention including debridement, selective blister drainage, fasciotomies, surgical salvage, skin grafts‚ and flaps are often necessary in these patients towards optimizing form and function. The true prevalence and incidence of frostbite injury is unknown. A centralized national database will improve our understanding of the diagnostic and management modalities used in frostbite care. Plastic surgeons have a critical role in the management of frostbite care and must work with an interdisciplinary team to identify the best treatment route for optimal patient care.

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Section: Resultsmentioning

confidence: 99%

Practical Review of the Current Management of Frostbite Injuries

Zaramo

Green

Janis

2022

Plastic and Reconstructive Surgery - Global Open

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“…Intracellular ice crystal formation stimulates a cascade of deleterious effects resulting in the production of prostaglandins, cytokines and oxygen free radicals as an intent to remove ice crystals and preserve cells. Notwithstanding, these products impoverish the cell environment and produce detrimental effects, such as hypoxia and microthrombosis, creating a vicious circle where the production of more substances is stimulated, resulting in cell death [2,9].…”

Section: Pathogenesismentioning

confidence: 99%

Bone Scintigraphy Outperformed Anatomic Images in Frostbite Injuries, a Case Report

Ronchi¹,

Peña²,

Albertti³

2022

Preprint

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Frostbite is a localized cold thermal injury, as a result of tissue exposure to temperatures below freezing point for a prolonged period of time .The spectrum of injury is broad, thus frostbite injuries may have deleterious effects with the possibility of losing part or whole extremities. We aim to present the case of a 38 years-old male patient evaluated with multiphase technetium-99m-methylene diphosphonate bone scintigraphy. This methodology may accelerate clinical management of frostbite injuries because it provides precise clinical-imaging correlation by determining the extent of injury and can accurately predict the level of amputation if required.

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“…Хотя нельзя исключить и первичное повреждение периферических нервов действием холода, с последующими нарушениями регуляторной и трофической иннервации. Данный вопрос в современной литературе практически не освещен и требует уточнения [3,8,13]. Также необходимо указать и наличие отека (дисбаланс Старлинга) в очаге альтерации и в перифокальных тканях, который, хоть и является патогенетически обоснованной и целесообразной реакцией организма на повреждение, но косвенно создает неблагоприятные условия для функционирования периферических нервов вследствие реализации многоуровневых межклеточных взаимодействий [10,12].…”

Section: динамика лимфоцитарно-тромбоцитарной адгезии и энмг у пострадавших с отморожениями (M±sd)unclassified

“…Solpov et al, 2006). Соответственно, снижение скорости кровотока в поврежденной конечности, которое наблюдается у всех пациентов с местной холодовой травмой [8,11,12], провоцирует резкое повышение миграции форменных элементов в интерстиций с усугублением отека и вторичной альтерацией тканей [13]. Нарушения межклеточных взаимодействий интегрально отражают состояние гемостаза, эндотелия и микроциркуляции.…”

Section: Introductionunclassified

Features of disturbances of microcirculation and intercellular interactions in local cold injury

Михайличенко

Шаповалов

Mudrov

et al. 2020

Regional blood circulation and microcirculation

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The aim of the work is to evaluate microcirculation, innervation and intercellular interactions depending on the severity and timing of cold tissue lesions. Materials and methods. 50 patients with III–IV degree of lower extremities local cold injury, as well as their blood were explored. Patients were divided into two groups depending on the period of clinical course: 5 and 30 days of cold injury. At the same time, the patients were divided into 3 groups according to the level of the lesion. The 1 group patients had only fingers frostbitten. Group 2 – patients had lesion boundary extended to the metatarsals and metatarsals. Patients with cold trauma of the proximal segments of the lower extremities belonged to group 3, had the damage level limited by the lower third of the low leg in the most cases. Studies in these groups were carried out on the 5th day after the injury. The phenomenon of lymphocytic-platelet rosette formation and the amplitude of M-response were evaluated. Results. In patients with frostbite, the increased adhesive ability of blood platelets to lymphocytes, was significantly decreased by 30 days. By the day 5, the number of lymphocyte-platelet rosettes increased 2.2 times, and the degree of adhesion 1.7 times. By the day 5 of the injury, the value of the M-response was reduced by 1.7, and the detected changes were preserved for day 30. In patients with fingers frostbitten, the percentage of LTA increased by 1.3 times, and the degree of adhesion by 1.5 times. Registered ENMG potentials decreased by 1.7 times. In group 2, the ability of platelets to adhere to lymphocytes increased by 1.6 times, and the average number of plates participated in rosette formation increased by 2.1. The registered ENMG potentials decreased by 2.5 times. In patients with the maximum level of cold tissue damage, the adhesive ability of lymphocytes and platelets increased by 3 times, and the degree of adhesion increased by 3.5 times, the amplitude of the M-response decreased by 2.6 times. Conclusions. The patients with local cold injury have been demonstrated the increasing of the platelets ability to adhesion to lymphocytes. The increasing of the number and degree of LTA was proportional to the level of tissues damaged by cold. Also, patients with frostbite had a sharp decreasing of in the amplitude of the M-response (motor response), which was getting worse with the increasing of severity of tissue damage. In the case of local cold injury, the maximum activity deviations in the activity of lymphocytic-lamellar interactions and the m-response amplitude of the electroneuromyography were recorded in the early period of cold injury, with a tendency to restore the wound process on the 30th day.

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The utility of bone scintigraphy with SPECT/CT in the evaluation and management of frostbite injuries

Cited by 17 publications

References 47 publications

Practical Review of the Current Management of Frostbite Injuries

Practical Review of the Current Management of Frostbite Injuries

Bone Scintigraphy Outperformed Anatomic Images in Frostbite Injuries, a Case Report

Features of disturbances of microcirculation and intercellular interactions in local cold injury

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