The value of technetium 99 scintigraphy in the prognosis of amputation in severe frostbite injuries of the extremities: A retrospective study of 92 severe frostbite injuries

Cauchy, Emmanuel; Marsigny, Bernard; Allamel, Guy; Verhellen, Rik; Chetaille, Eric

doi:10.1053/jhsu.2000.16357

Cited by 85 publications

(40 citation statements)

References 8 publications

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“…These include anticoagulant therapy, hyperbaric oxygen, and improved imaging modalities that quantifies non-viable tissue. [4][5][6][7][8][9] Although these new treatments are promising, the McCauley protocol might be considered the standard of care. Importantly, the evidence supporting the protocol or the individual treatments within it is lacking.…”

Section: Introductionmentioning

confidence: 99%

A retrospective cohort study examining treatments and operative interventions for frostbite in a tertiary care hospital

Fabian

Taljaard

Perry

2016

CJEM

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Background: Frostbite is a common yet challenging injury to both diagnose and treat. McCauley's frostbite treatment protocol consists of 12 treatments that might well represent the standard of care. However, its effectiveness in preventing operative intervention has yet to be examined. Our objectives were to characterize frostbite injuries in Eastern Ontario, identify risk factors for deep injuries, and assess the protocol's efficacy in preventing operative outcomes. Methods: This cohort study examined patients with frostbite over ten years at a tertiary care hospital. Demographics and predisposing factors were recorded. Frostbite severity was categorized into superficial or deep. Treatments were recorded, including adherence to protocol and operative outcome. Results: Of the 265 frostbite patients identified, deep frostbite accounted for 56 (21.1%, 95% CI: 16.2-26.1%), of whom 20 (35.7%) had an operative outcome. Amputation occurred in 16 (28.6%) of deep injuries and debridement in 5 (8.9%). Risk factors for deep frostbite were older age (p = 0.002), smoking (p <0.001), male sex (p = 0.056) and alcohol abuse (p = 0.056). None of the patients with deep frostbite had all 12 treatments performed. Adherence to protocol ranged from 0.0% to 48.2% per treatment. The rate of operative intervention was 7.7% in patients with deep frostbite who did not have any McCauley's frostbite treatments and ranged from 0.0% to 100.0% per treatment in those who did receive treatments. Conclusions: The frostbite protocol was not regularly followed and therefore its efficacy in preventing operative intervention could not be determined. Further, none of the individual treatments in the protocol were associated with preventing operative intervention. We recommend that future research focus on identifying effective individual treatments.

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Section: Introductionmentioning

confidence: 99%

A retrospective cohort study examining treatments and operative interventions for frostbite in a tertiary care hospital

Fabian

Taljaard

Perry

2016

CJEM

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Section: Radiographicsrsnaorgmentioning

confidence: 99%

“…The scan should be performed 2-4 days after the original injury, or after angiography is completed in patients who undergo intra-arterial thrombolysis (34)(35)(36)(37)(38). A repeat scan at 7-10 days after injury can then be performed as warranted before surgical resection to evaluate interval change in areas of questionable uptake identified at the prior scan (34,35). By using this approach, the approximate level of amputation can be accurately predicted in up to 84% of cases at the initial scan, weeks before the demarcation of viable and nonviable tissue is clearly apparent at physical examination (34,36,39).…”

Section: Radiographicsrsnaorgmentioning

confidence: 99%

“…A repeat scan at 7-10 days after injury can then be performed as warranted before surgical resection to evaluate interval change in areas of questionable uptake identified at the prior scan (34,35). By using this approach, the approximate level of amputation can be accurately predicted in up to 84% of cases at the initial scan, weeks before the demarcation of viable and nonviable tissue is clearly apparent at physical examination (34,36,39). Specificity increases at subsequent scanning as ongoing healing and necrosis resolve areas of questionable uptake (34,35).…”

Section: Radiographicsrsnaorgmentioning

confidence: 99%

“…By using this approach, the approximate level of amputation can be accurately predicted in up to 84% of cases at the initial scan, weeks before the demarcation of viable and nonviable tissue is clearly apparent at physical examination (34,36,39). Specificity increases at subsequent scanning as ongoing healing and necrosis resolve areas of questionable uptake (34,35). If feasible, débridement of blisters should be undertaken before scanning to limit false-positive results caused by pooling of tracer within blisters during the soft-tissue phase (34,35).…”

Section: Radiographicsrsnaorgmentioning

confidence: 99%

See 2 more Smart Citations

Frostbite: Spectrum of Imaging Findings and Guidelines for Management

Millet¹,

Brown²,

Levi³

et al. 2016

RadioGraphics

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Cutaneous Reactions to Cold and Heat

Bashir,

Chew

2016

Rook's Textbook of Dermatology, Ninth Edition

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Human exposure to cold and warm environments has occurred throughout millennia. Human skin responds physiologically to environmental temperature; however, pathological responses may occur to extremes of temperature in those who have an underlying predisposition. This chapter details the pathophysiological responses to cold and heat, the resultant disease processes and the treatment plans used to manage patients injured by cold or heat.

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The value of technetium 99 scintigraphy in the prognosis of amputation in severe frostbite injuries of the extremities: A retrospective study of 92 severe frostbite injuries

Cited by 85 publications

References 8 publications

A retrospective cohort study examining treatments and operative interventions for frostbite in a tertiary care hospital

A retrospective cohort study examining treatments and operative interventions for frostbite in a tertiary care hospital

Frostbite: Spectrum of Imaging Findings and Guidelines for Management

Cutaneous Reactions to Cold and Heat

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