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The Emerging Role of Tissue Plasminogen Activator in the Management of Severe Frostbite

Ibrahim, Amir E. MD*; Goverman, Jeremy MD*; Sarhane, Karim A. MD, MSc; Donofrio, Jill DO, MPH; Walker, T. Gregory MD§; Fagan, Shawn P. MD*

doi: 10.1097/BCR.0000000000000135
Original Articles

This article presents a small case series demonstrating clinical success with thrombolytic agents for severe frostbite injury to the lower extremities. The authors report three patients with severe frostbite injuries to their distal lower extremities who were managed with urgent interventional radiology and intra-arterial tissue plasminogen activator infusion according to a prespecified protocol. Limbs and digits were successfully salvaged and patients returned to normal activity within 2 weeks. Although further studies are needed, results of this study support a new approach in the management of frostbite: from conservative management and observation to urgent interventional radiology and possible tissue plasminogen activator infusion. A protocol for the management of such injuries is presented.

From the *Division of Burns, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland; UNECOM/Kent Hospital Emergency Medicine Program, Warwick, Rhode Island; and §Department of Radiology, Massachusetts General Hospital, Boston.

Address correspondence to Jeremy Goverman, MD, Division of Burns, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114.

© 2015 The American Burn Association