Frostbite Injury Management in Emergency

  • Emmanuel Cauchy
  • Scrimgeour Carron
  • Rik Verhellen
  • Fontanille Bernard
  • Frostbite of the extremities affects two distinct groups of people: an ‘at-risk’ urban population, mainly the homeless, and persons exposing themselves to an arctic environment, i.e., climbers, polar explorers, etc.

  • A localized cold-induced lesion, or frostbite, is defined as tissue injury resulting from the prolonged exposure of flesh to a temperature of less than 0°C.

  • Improvement in the quality of textiles and clothing protections diminishes the impact of frostbite, yet it can still develop because of an insidious and painless onset.

  • Frostbite injury most often involves the hands and feet, and less often the ears, nose and cheeks.

  • Frostbite can result in catastrophic amputations, sometimes quite proximally on the affected limbs of previously healthy young men.

  • A new classification of frostbite, based on initial clinical examination, has the advantage of establishing a long-term prognosis early on in the management of frostbite.

  • Thrombolytic agents and prostacyclin used in the early phase of treatment of frostbite offer new hope to reduce the risk of amputation and sequelae from frostbite injury.


Bone Scanning Thrombolytic Agent Hyperbaric Oxygen Therapy Initial Lesion Cold Injury 
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  1. 1.
    Knize DM, Weatherley-White RC, Paton BC, Owens JC. Prognostics factors in the management of frostbite. J Trauma. 1969; 9: 749.PubMedCrossRefGoogle Scholar
  2. 2.
    Heggers JP, Robson MC, Manavalen K et al. Experimental and clinical observations on frostbite. Ann Emerg Med. 1987; 16: 1056–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Groechenig E. Treatment of frostbite with iloprost (letter). Lancet. 1994; 344(8930): 1152–3.PubMedCrossRefGoogle Scholar
  4. 4.
    Skolnick AA. Early data suggest clot-dissolving drug may help save frostbitten limb amputation (news). JAMA. 1992; 267: 2008–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Zdeblick TA, Field GA, Shaffer JW. Treatment of experimental frostbite with urokinase. J Hand Surg [Am]. 1988; 13(6): 948–53.CrossRefGoogle Scholar
  6. 6.
    Voinov AI. Clinical classification of cold injury and prognostication of the depth of tissue damage during the acute period. Klin Khir. 1989; 12: 41–43.PubMedGoogle Scholar
  7. 7.
    Chernetsov AA. The classification and treatment of frostbite. Voen Med Zh. 1992; 10: 26–28.PubMedGoogle Scholar
  8. 8.
    Botta-Kauer Y. Les brûlures de la main. Med et Hyg. 1997; 55: 2369–72.Google Scholar
  9. 9.
    Mills WJ Jr. Clinical aspects of frostbite injury. In: Proceeding of the Symposium on Artic Medicine and Biology. IV. Frostbite, Fort Wainwright, Alaska: Artic Aeromedical Laboratory, 1964.Google Scholar
  10. 10.
    Mills WJ. Summary of treatment of the cold injured patient: frostbite. Alaska Med. 1993; 35: 61–6.PubMedGoogle Scholar
  11. 11.
    Cauchy E, Chetaille E, Lefevre M, Kerelou E, Marsigny B. The role of bone scanning in severe frostbite of the extremities. A retrospective study of 88 cases. Eur J Nucl Med. 2000; 48: 497–502.CrossRefGoogle Scholar
  12. 12.
    Cauchy E, Chetaille E, Marchand V, Marsigny B. Retrospective study of 70 cases of severe frostbite lesions: a proposed new classification sheme. Wilderness Environ Med. 2001; 12(4): 248–55.PubMedGoogle Scholar
  13. 13.
    Bruen KJ, Ballard JR, Morris SE et al. Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy. Arch Surg. 2007; 142: 546–553.PubMedCrossRefGoogle Scholar
  14. 14.
    Valnicek SM, Chasmar LR, Clapson JB. Frostbite in the prairies: a 12-year review. Plast Reconstr Surg. 1993; 92: 633–41.PubMedCrossRefGoogle Scholar
  15. 15.
    Reamy B V. Frostbite: review and current concepts. J Am Board Fam Prac. 1998; 11(1): 34–40.Google Scholar
  16. 16.
    Pollard AJ, Murdoch DR. The high altitude medicine handbook. Abingdon: Radcliffe Medical Press, 2003.Google Scholar
  17. 17.
    Killian H. Terminology and division into groups of localised cold injuries. In: Cold and Frost Injuries. Berlin: Springer-Verlag, 1981; pp 25–37.Google Scholar
  18. 18.
    Washburn B. Frostbite. N Eng J Med. 1962; 266: 974–89.Google Scholar
  19. 19.
    Boswick JA Jr., Thompson TD, Jonas RA. The epidemiology of cold injuries. Surg Gynecol Obstet. 1979; 149: 326–32.PubMedGoogle Scholar
  20. 20.
    Mills WJ. Summary of treatment of the cold injured patient: frostbite. Alaska Med. 1993; 35: 61–66.PubMedGoogle Scholar
  21. 21.
    Merymann HT. Freezing injury and its prevention in living cells. Annu Rev Biophys Bioeng 1974; 3: 341–63.CrossRefGoogle Scholar
  22. 22.
    Manson PN, Jesudass R, Marzella L, Bulkley GB, Im MJ, Narayan KK. Evidence for an early free radical-mediated reper-fusion injury in frostbite. Free Radic Biol Med 1991; 10: 7–11.CrossRefGoogle Scholar
  23. 23.
    Robson MC, Heggers JP. Evaluation of frostbite blister fluid as a clue to pathogenesis. J Hand Surg [Am]. 1981; 6: 43–47.Google Scholar
  24. 24.
    Raine TJ et al. Antiprostaglandins and antithromboxanes in the treatment of frostbite. Surg Forum. 1980; 31: 557–8.Google Scholar
  25. 25.
    McCauley RL, Smith DJ, Robson MC, Heggers JP. Frostbite. In Wilderness Medicine by Auerbach PS (ed.). St Louis: Mosby, 2001 (4th ed).Google Scholar
  26. 26.
    Barker JR, Haws MJ, Brown RE, Kucan JO, Moore WD. Magnetic resonance imaging of severe frostbite injuries. Ann Plast Surg 1997; 38: 275–9.CrossRefGoogle Scholar
  27. 27.
    MartínezVillén G, Morandeira JR. Patología localizada por acción del frío: “congelaciones”. In: Morandereira JR, Martínez Villén G, Masgrau L, Avellanas M, editors. Manual Básico de medicina de montaña. Zaragova: Prames, 1996. pp. 171–4Google Scholar
  28. 28.
    Taylor MS. Lumbar Epidural Sympathectomy for frostbite injuries of the feet. Mil Med. 1999; 164: 566–567.PubMedGoogle Scholar
  29. 29.
    Murphy JV, Banwell PE, Roberts AHN, McGrouther AD. Frostbite: pathogenesis and treatment. J Trauma. 2000; 48(1): 171–178.PubMedCrossRefGoogle Scholar
  30. 30.
    Heimburg D, Noah ME, Siekmann UPF, Pallua N. Hyperbaric oxygen treatment in deep frost bite of both hands in a boy. Burns. 2001; 27: 404–408.CrossRefGoogle Scholar
  31. 31.
    Finderle Z, Cankar K. Delayed treatment of frostbite injury with hyperbaric oxygen therapy: a case report. Av Spc Env Med. 2002; 73(4): 393–394.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Emmanuel Cauchy
    • 1
  • Scrimgeour Carron
    • 1
  • Rik Verhellen
    • 1
  • Fontanille Bernard
    • 1
  1. 1.IFREMMONT, Institut de Formation et de Recherche en Médecine de Montagne, Hôpital de ChamonixChamonixFrance

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