Living in a cold weather climate such as Wisconsin may increase a person’s risk of frostbite injury. The good news is that you can protect yourself and prevent frostbite by wearing proper clothing for outdoor activities. If frostbite does occur, timely diagnosis and treatment are essential to maximizing tissue preservation.
Frostbite injury occurs in phases
Frostbite occurs when body tissues freeze due to cold temperature exposure, most commonly impacting ears, nose, cheeks, fingers and toes. Rewarming efforts will not help in these conditions. Exposure to extreme cold and rapid freezing may cause ice crystals to form inside cells. That causes inflammation that can lead to necrosis (tissue death) as the tissue thaws.
Cold-induced injury can be associated with outdoor recreational activities, working in cold temperatures without proper clothing, and being stranded outdoors during the winter. In some frostbite situations in Wisconsin, alcohol is a contributing factor.
“When alcohol is involved, individuals regularly do not seek medical attention quickly enough and permanent tissue damage may occur by the time they reach an emergency department,” said Amy Kramas, registered nurse and burn program coordinator at Marshfield Clinic Health System. “Twenty-four hours or less from the time of thawing is critical.”
Treatment depends on the extent of the frostbite injury, the time of thawing and when the individual seeks medical attention. Here are four current treatment approaches.
In thrombolytic therapy, an interventional radiologist uses a baseline angiography to determine the blood flow and circulation to the injured area. If the patient meets certain criteria, medication is instilled directly into the vessels to help break up and dissolve the crystals and clots caused by frostbite. This helps restore circulation to the area. Thrombolytic therapy requires close monitoring and a stay in the intensive care unit.
This treatment is used in moderate to severe frostbite injuries for patients who meet specific criteria. One of those markers is seeking medical attention within 24 hours of thawing.
“Marshfield Medical Center does provide thrombolytic therapy for patients who meet that criteria,” Kramas said. “The faster we can get the patients here, evaluate them and begin thrombolytic therapy, the better the results they have for tissue preservation.”
Topical wound care (wait and watch)
Topical wound care is the most common treatment for frostbite. Some form of wound care is required for most frostbite injuries, especially in moderate to severe frostbite cases where the thawing of tissue is greater than 24 hours.
Providers will wait to determine the extent of tissue damage. The waiting and watching portion can take up to six months. Treatment will require continued outpatient wound care appointments and close monitoring by the provider. The provider will surgically remove the dead tissue once it’s been determined.
Hyperbaric oxygen treatment
Hyperbaric oxygen treatment, or HBOT, is used in conjunction with topical wound care. HBOT has been shown in studies to reduce tissue loss in some frostbite injuries. This treatment helps to improve the viability of damaged tissue, and some cases, decrease the need for surgical debridement and amputation.
With HBOT, a patient is placed into a pressurized hyperbaric oxygen therapy chamber. The patient receives high oxygen levels and the air pressure in the chamber is increased gradually to a level that is two to three times higher than normal air pressure. HBOT increases the amount of oxygen that blood can carry, which helps to increase the amount of oxygen delivered to injured tissue from frostbite. Tissue requires more oxygen to heal when it’s been injured. HBOT treatments provide higher levels of blood oxygen which encourages tissue healing.
Surgical removal of tissue or amputation
Surgical removal of tissue and/or amputation is the last resort and is common with patients who wait too long to seek medical attention.
“It’s important to remember with frostbite that every second counts, from the time of frostbite injury to the start of thawing tissue,” Kramas said. “Make your way to the emergency department as soon as possible as time is tissue.”