Chemical Injuries and Frostbite-Treatment of Digital Frostbite: Current Concepts

Treatment of Digital Frostbite: Current Concepts

Pdf Summary

Thrombolytic therapy is emerging as a potential treatment for severe frostbite and has shown promise in saving digits and limiting the need for amputation. Frostbite injury involves a cascade of events that begin with tissue freezing and result in tissue ischemia. Thrombolytic therapy, such as tissue plasminogen activator (tPA), can lyse clots in the microvasculature and prevent the sequelae of ischemia-reperfusion. <br />Frostbite can be categorized into superficial and deep involvement, with varying degrees of tissue necrosis. Supportive measures, including hypothermia support and transfer to a high-level center, are recommended. <br />Thrombolytic therapy can be administered locally via catheter-directed therapy or systemically via intravenous therapy. The choice of therapy depends on the patient's perfusion evaluation. Heparin is often given concurrently with thrombolytic therapy to prevent hemorrhage. <br />In patients with severe frostbite and early initiation of thrombolytic therapy, the reported digital salvage rate is high. However, delayed presentation and repeated episodes of freeze-thaw cycles are associated with treatment failure. <br />Thrombolytic therapy should be considered in patients with severe frostbite who present soon after exposure and should be initiated at a facility capable of performing the therapy. The best method of delivery, time limitations, and duration of therapy, as well as the effectiveness of newer-generation thrombolytic agents, are still under investigation.

Keywords

Thrombolytic therapy

severe frostbite

digits

amputation

tissue ischemia

tissue plasminogen activator

ischemia-reperfusion

tissue necrosis

catheter-directed therapy

intravenous therapy