Frostbite
Frostbite results from prolonged exposure to below zero temperature.
The risk is increased in people with poor circulation or at high
altitude due to decreased oxygen tension in the air.
Tissue freezing causes local disruption in circulation and
vascular damage, further leading to swelling and blistering that is
complicated with thrombosis. Soft tissue damage can cause compartment
syndrome and damage of peripheral nerves and tissue necrosis (tissue
death).
These events can take longer time, even weeks to evolve and hyperbaric
oxygen therapy is essential in breaking the vicious circle of tissue
deprivation by blood supply (ischemia) and oxygen (hypoxia), which
leads to further tissue loss.
Oxygen
Role
Many
clinical reports are showing that early oxygen intervention enhances
healing and and cell regeneration. Best time to apply
oxygen is during rewarming, when oxygen demands are greatest
but
ability to deliver oxygen is compromised. Oxygenated tissue is less
prone to ischemia-reperfusion injury, swelling,
infection and
whole compartment syndrome, saving fingers
and toes from amputation. Oxygen therapy improves the microcirculation
thru angiogenesis (new capillary growth), strengthens the
immune
system response and enables peripheral nerve regeneration for return of
sensitivity and
function to affected limb (see examples below).
Good results with oxygen can be achieved even weeks after injury if the
circulation is not substantially damaged (see
ref).
Early warning signs
Frostbite is a progressive injury where serious complications can arise
days or even weeks after exposure. Superficial redness, burning
tingling and numbness are signs of compromised
micro-circulation. Tissue oxygen status can be assessed with
micro-vascular assessment.
If micro-circulation is reestablished tissue can be saved and
amputation prevented.
Symptoms:
burning, tingling and gradual numbness; initial redness turns into
gray/blue appearance; blistering of the skin in the final stage turns
into necrosis of the skin and underlying soft tissue.
Early start of oxygen therapy
can save the injured tissue and prevent amputation.
"Because
of the low risk associated with hyperbaric oxygen therapy, and its
potential therapeutic efficiency, hyperbaric therapy should be
recommended as adjunct therapy in the treatment of deep frostbite"
If circulation is not
substantially damaged, excellent results can be achieved even weeks
after frostbite injury.
(see Case File below)
Benefits of
hyperbaric oxygen therapy in acute and delayed frostbite injury
- improves
tissue oxygenation
- improves
tissue micro-circulation by enhancing capillary growth
- reduces
tissue swelling and progression of the compartment syndrome
- reduces
pain
- reduces
and
prevents infection by
- inhibiting bacterial growth
- increasing activity of white blood cell to destroy
bacteria
- improving body's defense mechanism
- enables
quick demarcation of the necrotic tissue from the viable, so that part
of the involved tissue can be salvaged
- reduces the
need for surgical intervention and amputation
- enhances
wound healing
- reduces
possibility of thrombosis by acting as natural
anticoagulant
- enhances
peripheral nerve regeneration and return of sensitivity
|
Case file 1: Delayed treatment of frosbite injury
Source:
"Hyperbaric Oxygen
Therapy for a Delayed
Frostbite Injury"
Brian F. McCrary, DO,
MPH; Timothy A. Hursh, MD, MPH
Wounds. 2005;17(12):327-331
Non
smoker, 28 year old mountain climber was trapped in snow for three days
before descending to acute facility. She was diagnosed with Grade III
frostbites to the third and fourth fingers of the right hand and fourth
finger of the left hand, but was not treated and discharged with a
topical gel and pain medication. Hyperbaric treatment was
initiated 22 days
after injury.
Treatment protocol
After 22 days delay hyperbaric oxygen
therapy was initiated and 21 daily session of 90 minutes at pressures
up to 2.5 ATA were given in combination with wound care. After three
sessions clear demarcation was seen between the viable healthy tissue
and necrotic tissue. Wound debridment with antibiotic
ointments
that was debrided.
Treatment outcome
After receiving 21 hyperbaric and wound care
treatments over a 5-week period complete recovery with only superficial
sloughing at the fingertips was seen. Sensitivity returned in all
fingers.
Before hyperbaric therapy:
Photos
reproduced with permission from author. Original source link here
After 21 hyperbaric sessions:
Photos
reproduced with permission from author. Original source link here
Comments
Treatment
of frostbite is not routinely covered by medical insurance and is still
on the list of investigational conditions of the
UHMS. Positive
treatment results with hyperbaric oxygen can be expected if early
intervention is applied. However, if circulation is not substantially
damaged, excellent results can be achieved even weeks after
injury.
Case file 2: Frostbite
Source:
"Hyperbaric oxygen
treatment in deep frostbite of both hands in a boy."
von Heimburg D, Noah EM, Sieckmann UP, Pallua N.
Burns.
2001;27(4):404–408
11-year-old boy who
suffered
deep frostbite on six fingers while he was working outdoor at
temperatures of -32 degrees C over
a 4 hour period.
Treatment protocol
Three days later he was for the first time seen by a physician, who
planned to
amputate the affected fingers, but the family transferred the boy to
the
University Hospital in Aachen, Germany to Dr. von Heimburg. He treated
him with
hyperbaric oxygen daily for 14 days at 2.4 ATA for 90
minutes.
Treatment outcome
A total
recovery
of the severe frostbite was observed after 14 days of oxygen treatment.
Twenty-eight months after the injury the boy reports fully regained
sensibility
and no pain.
Conclusions
Because of the low risk associated with HBO,
and its potential therapeutic efficiency, HBO should be
recommended as
adjunct therapy in the treatment of deep frostbite
- Jain KK: Textbook of hyperbaric medicine: Ch 14:
Hyperbaric Oxygen Therapy in wound healing, plastic surgery and
dermatology, Hogrefe& Huber Publishers, Inc., 3rd Ed.22:
213–241, 1999.
- "Hyperbaric
Oxygen
Therapy for a Delayed
Frostbite Injury", McCrary BF, Hursh TA, Wounds. 2005;17(12):327-331
-
"Hyperbaric
oxygen treatment in deep frostbite of both hands in a
boy", von Heimburg D, Noah EM, Sieckmann UP, Pallua
N.,
Burns.
2001;27(4):404–408
