Frostbite, once almost exclusively a military problem, is becoming more prevalent among the general population and should now be considered to be within the scope of the civilian physician’s practice. Studies into the epidemiology of civilian frostbite have identified several risk factors that may aid the clinician in the diagnosis and management of cold injuries. Research into the pathophysiology has revealed marked similarities in inflammatory processes to those seen in thermal burns and ischemia/reperfusion injury. Evidence of the role of thromboxanes and prostaglandins has resulted in more active approaches to the medical treatment of frostbite wounds. Although the surgical management of frostbite involves delayed debridement 1 to 3 months after demarcation, recent improvements in radiologic assessment of tissue viability have led to the possibility of earlier surgical intervention. In addition, several adjunctive therapies, including vasodilators, thrombolysis, hyperbaric oxygen, and sympathectomy, are discussed.
From the Burns and Reconstructive Surgery Research Trust, Stoke Mandeville Hospital, United Kingdom (J.M., P.B., A.R.), and the Phoenix Tissue Repair Unit, Department of Plastic Surgery, University College, London, United Kingdom (P.B., D.M.).
Submitted for publication September 11, 1998.
Address for reprints: James Murphy, MB, CHB, Stoke Mandeville Hospital, Dept of Plastic/Recon Surg, Mandeville Rd., Aylesbury, Bucks, HP21 8AL, England; Fax: 44 1296 315182.
Accepted for publication January 4, 1999.