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Ma X, Pouoh JT, Hogue BT, Bougie E. Frostbite in the Pediatric Population: A Comprehensive Review and a Prospective Canadian Survey. Pediatr Emerg Care 2024; 40:611-617. [PMID: 38206303 DOI: 10.1097/pec.0000000000003109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Frostbite in the pediatric population, where skeletal maturity has not been achieved, can have important repercussions on subsequent growth. Yet, the optimal management of frostbite injuries in children remains vague. This review aims to summarize the current evidence for frostbite management in children and understand Canadian practice trends on this topic. METHODS A review using Medline, Scopus, Web of Science, and gray literature was performed to identify relevant literature on the clinical manifestations, diagnostic methods, and treatment options in pediatric frostbite. An online survey was sent to plastic surgeons through the Canadian Society of Plastic Surgeons (CSPS) mailing list to further identify national practices and trends for pediatric frostbite management. RESULTS A total of 109 articles were reviewed. No article provided a specific algorithm for pediatric frostbite, with existing recommendations suggesting the use of adult guidelines for treating children. Our survey yielded 9 responses and highlighted the rarity of pediatric frostbite cases, with no responder treating more than 10 cases per year. Most (55.6%) do not use a pediatric-specific treatment algorithm, whereas 30% apply adult guidelines. A conservative approach focusing on rewarming (55.6%), limb elevation (50%), and tetanus status verification (66.7%) was predominant. Imaging and surgical interventions seem to be reserved for severe cases. CONCLUSIONS The current literature for pediatric frostbite management lacks specificity. Canadian practices vary, with a trend toward a conservative approach. The limited evidence and rarity of experience highlight the need for further research, ideally in a collaborative multicentric manner, to create a consensus for pediatric frostbite care.
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Affiliation(s)
- Xiya Ma
- From the Division of Plastic Surgery, Université de Montréal, Montreal, Quebec, Canada
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2
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McIntosh SE, Freer L, Grissom CK, Rodway GW, Giesbrecht GG, McDevitt M, Imray CH, Johnson EL, Pandey P, Dow J, Hackett PH. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2024 Update. Wilderness Environ Med 2024; 35:183-197. [PMID: 38577729 DOI: 10.1177/10806032231222359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the guidelines published in 2019.
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Affiliation(s)
- Scott E McIntosh
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | - Luanne Freer
- Everest ER, Himalayan Rescue Association, Kathmandu, Nepal
| | - Colin K Grissom
- Department of Critical Care Medicine, Intermountain Medical Center, Murray, UT
| | - George W Rodway
- Department of Family Medicine - Sports Medicine, School of Medicine, University of Nevada, Reno, NV
| | - Gordon G Giesbrecht
- Faculty of Kinesiology and Recreation Management, Departments of Anesthesia and Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Marion McDevitt
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | - Christopher H Imray
- Warwick Medical School, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Eric L Johnson
- Community Faculty, Family Medicine, University Nevada-Reno, Reno, NV
| | | | - Jennifer Dow
- Denali National Park and Preserve, Denali Park, AK
| | - Peter H Hackett
- Altitude Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO
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3
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Wibbenmeyer L, Lacey AM, Endorf FW, Logsetty S, Wagner ALL, Gibson ALF, Nygaard RM. American Burn Association Clinical Practice Guidelines on the Treatment of Severe Frostbite. J Burn Care Res 2024; 45:541-556. [PMID: 37045447 DOI: 10.1093/jbcr/irad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
This Clinical Practice Guideline addresses severe frostbite treatment. We defined severe frostbite as atmospheric cooling that results in a perfusion deficit to the extremities. We limited our review to adults and excluded cold contact or rapid freeze injuries that resulted in isolated devitalized tissue. After developing population, intervention, comparator, outcomes (PICO) questions, a comprehensive literature search was conducted with the help of a professional medical librarian. Available literature was reviewed and systematically evaluated. Recommendations based on the available scientific evidence were formulated through consensus of a multidisciplinary committee. We conditionally recommend the use of rapid rewarming in a 38 to 42°C water bath and the use of thrombolytics for fewer amputations and/or a more distal level of amputation. We conditionally recommend the use of "early" administration of thrombolytics (≤12 hours from rewarming) compared to "later" administration of thrombolytics for fewer amputations and/or a more distal level of amputation. No recommendation could be formed on the use of vascular imaging studies to determine the use of and/or the time to initiate thrombolytic therapy. No recommendation could be formed on the use of intravenous thrombolytics compared to the use of intra-arterial thrombolytics on fewer amputations and/or a more distal level of amputation. No recommendation could be formed on the use of iloprost resulting in fewer amputations and/or more distal levels of amputation. No recommendation could be formed on the use of diagnostic imaging modalities for surgical planning on fewer amputations, a more distal level of amputation, or earlier timing of amputation.
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Affiliation(s)
- Lucy Wibbenmeyer
- Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
| | | | | | - Sarvesh Logsetty
- Departments of Surgery, Psychiatry, and Children's Health, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| | - Anne L L Wagner
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Angela L F Gibson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Rachel M Nygaard
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN 55415, USA
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Affiliation(s)
- Robert L Sheridan
- From the Departments of Surgery (R.L.S., J.M.G.) and Radiology (T.G.W.), Massachusetts General Hospital, and Boston Shriners Hospital for Children (R.L.S., J.M.G.) - both in Boston
| | - Jeremy M Goverman
- From the Departments of Surgery (R.L.S., J.M.G.) and Radiology (T.G.W.), Massachusetts General Hospital, and Boston Shriners Hospital for Children (R.L.S., J.M.G.) - both in Boston
| | - T Gregory Walker
- From the Departments of Surgery (R.L.S., J.M.G.) and Radiology (T.G.W.), Massachusetts General Hospital, and Boston Shriners Hospital for Children (R.L.S., J.M.G.) - both in Boston
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5
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Xiao Y, Hao D, Xin Y, Jiang X. A Tibetan adolescent girl suffered frostbite on the journey of pilgrimage: A case report. Chin J Traumatol 2022; 25:184-186. [PMID: 34815140 PMCID: PMC9125723 DOI: 10.1016/j.cjtee.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 08/30/2021] [Accepted: 09/20/2021] [Indexed: 02/05/2023] Open
Abstract
Frostbite in Southwestern China has been overlooked due to its low incidence, relatively mild temperature and lack of literature published before. However, it needs to be further studied for religious diversity and distinct geomorphology. In this article, we reported an 18-year-old Tibetan girl who suffered from blizzard attack during pilgrimage. Her feet and several fingers showed mummified gangrene upon physical examination with poor movement. She was diagnosed with 3rd to 4th degree of frostbite. The girl was given oral ibuprofen, debridement and other regular treatment daily, but she was eventually amputated due to insufficient thrombolytic management in primary hospital, delayed informing consent in the referral hospital and ethnic conflict between religion and guidelines. This case enriched the experience of managing complex frostbite in Tibetan population and alarms that efforts should be integrated to protect pilgrims and mountaineers in the Tibetan region.
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Affiliation(s)
- Yue Xiao
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Dan Hao
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yue Xin
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China.
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FROSTBITE OF THE UPPER EXTREMITIES: HOT ISSUES IN DIAGNOSIS AND SURGICAL TREATMENT (review). Burns 2022; 48:1279-1286. [DOI: 10.1016/j.burns.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/16/2022] [Accepted: 03/12/2022] [Indexed: 11/24/2022]
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7
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Rogers C, Lacey AM, Endorf FW, Gopal P, Whitley A, Gayken J, Fey R, Schmitz K, Nygaard RM. The Effects Of Rapid Rewarming On Tissue Salvage In Severe Frostbite Injury. J Burn Care Res 2021; 43:906-911. [PMID: 34791315 DOI: 10.1093/jbcr/irab218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Frostbite is a high morbidity injury caused by soft tissue freezing, which can lead to digit necrosis requiring amputation. Rapid rewarming is a first line treatment method that involves placing affected digits into a warm water bath. This study aims to assess the clinical practices for frostbite at facilities outside of dedicated burn centers, and any impact these practices have on tissue salvage. Retrospective chart review at a single burn center identified frostbite patients admitted directly or as transfers over a seven-year period. Records were reviewed to identify initial treatment strategies. If given, time to thrombolytics from admit was noted. Tissue salvage rates were calculated from radiologically derived tissue at-risk scores and final amputation scores. One-hundred patients were transferred from outside facilities, and 108 were direct admissions (N=208). There was no significant difference in group demographics. Rapid rewarming was the initial treatment modality more commonly in direct admit patients (P=0.016). The use of rapid rewarming did not correlate with tissue salvage (P=0.112). Early use of thrombolytics had a positive impact on tissue salvage (P=0.003). Thrombolytics were given 1.2 hours earlier in direct admit patients (P=0.029), however there was no difference in tissue salvage rates between the groups (P=0.127). Efforts should focus on larger scale study to further assess the effectiveness of rapid rewarming. Although rapid rewarming did not significantly impact tissue salvage in this study, we continue to recommend its use over less studied treatment methods, and continue to view it as an important bridge to burn center transfer and administration of thrombolytic therapy.
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Affiliation(s)
| | | | | | - Punjabi Gopal
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN
| | - Angela Whitley
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN
| | - Jon Gayken
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN
| | - Ryan Fey
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN
| | - Kyle Schmitz
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN
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8
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Gao Y, Wang F, Zhou W, Pan S. Research progress in the pathogenic mechanisms and imaging of severe frostbite. Eur J Radiol 2021; 137:109605. [PMID: 33621855 DOI: 10.1016/j.ejrad.2021.109605] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This article reviews the pathological mechanisms and progress of imaging of severe frostbite to assist in the search for targets for clinical diagnosis and treatment of severe frostbite. This review also aims to provide strong evidence for clinical diagnosis and treatment of deep frostbite. METHODS The review was based on the summary and analysis of the existing literature, and explored the pathological mechanism of deep frostbite and the advantages and disadvantages of imaging diagnostic methods. RESULTS According to the depth of tissue involvement, frostbite is divided into 4 levels. Severe frostbite includes Grade 3 and Grade 4 frostbite. Clinical performance evaluation and imaging diagnostic research have always been the mainstream of severe frostbite diagnosis. Imaging methods focus on vascular patency and tissue vitality. This article introduces angiography, SETCT/CT and MRA, and we summarize the advantages and disadvantages of these imaging methods. We recommend corresponding imaging modalities according to the state of frostbite patients. CONCLUSIONS Imaging examination, especially angiography and bone scans, provide useful information for determining the diagnosis and prognosis of severe frostbite. In order to obtain a good clinical prognosis, clinicians should first perform SPECT/CT. MRA does not burden the patient's body, but the balance between cost and benefit must be considered. Angiography provides a good feedback on the changes in blood vessel status before and after treatment, which is helpful for discovering the response of limbs to treatment.
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Affiliation(s)
- Yue Gao
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fengzhe Wang
- Department of Radiology, the Fourth People's Hospital of Shenyang: Shenyang Medical College, Shenyang, China
| | - Wei Zhou
- Department of Radiology, General Hospital of Northern Military Area: General Hospital of Northern Theatre Command, Shenyang, China
| | - Shinong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
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9
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Utilization of bone scan and single photon emission computed tomography on amputation planning in acute microvascular injury: Two cases. Foot (Edinb) 2019; 40:109-115. [PMID: 31675679 DOI: 10.1016/j.foot.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/21/2019] [Accepted: 08/18/2019] [Indexed: 02/04/2023]
Abstract
The use of single photon emission computer tomography (SPECT/CT) in acute vascular injury is not well documented. SPECT/CT combines the anatomic detail of computer tomography with the functional vascular perfusion of photon emission to determine the viability of osseous structures and surrounding soft tissue. The superimposed imaging provides the practitioner with a reliable anatomic image of viability of a specific anatomic area following insult or injury. We present two cases, bilateral lower extremity frostbite, and symmetric peripheral gangrene in which this imaging modality provided guidance for surgical intervention with adequate predictability and results.
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10
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McIntosh SE, Freer L, Grissom CK, Auerbach PS, Rodway GW, Cochran A, Giesbrecht GG, McDevitt M, Imray CH, Johnson EL, Pandey P, Dow J, Hackett PH. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update. Wilderness Environ Med 2019; 30:S19-S32. [PMID: 31326282 DOI: 10.1016/j.wem.2019.05.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/14/2019] [Accepted: 05/17/2019] [Indexed: 12/13/2022]
Abstract
The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the guidelines published in 2014.
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Affiliation(s)
- Scott E McIntosh
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT.
| | - Luanne Freer
- Everest Base Camp Medical Clinic, Nepal; Yellowstone National Park, WY
| | - Colin K Grissom
- Division of Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT
| | - Paul S Auerbach
- Department of Emergency Medicine, Stanford University, School of Medicine, Palo Alto, CA
| | - George W Rodway
- College of Nursing and School of Medicine, UC Davis, Davis, CA
| | - Amalia Cochran
- Department of Surgery, The Ohio State University, Columbus, OH
| | - Gordon G Giesbrecht
- Faculty of Kinesiology and Recreation Management, Departments of Anesthesia and Emergency Medicine, University of Manitoba, Winnipeg, Canada
| | - Marion McDevitt
- Emergency Medicine, Peace Health Ketchikan Medical Center, Ketchikan, AK
| | - Christopher H Imray
- Warwick Medical School, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Eric L Johnson
- Wound & Hyperbaric Medicine, Bozeman Health, Bozeman, MT
| | | | | | - Peter H Hackett
- Division of Emergency Medicine, Altitude Research Center, University of Colorado Denver School of Medicine, Denver, CO; Institute for Altitude Medicine, Telluride, CO
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11
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Lacey AM, Fey RM, Gayken JR, Endorf FW, Schmitz KR, Punjabi GV, Masters TC, Nygaard RM. Microangiography: An Alternative Tool for Assessing Severe Frostbite Injury. J Burn Care Res 2019; 40:566-569. [DOI: 10.1093/jbcr/irz112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Assessment of frostbite injury typically relies on computed tomography, angiography, or nuclear medicine studies to detect perfusion deficits prior to thrombolytic therapy. The aim of this study was to evaluate the potential of a novel imaging method, microangiography, in the assessment of severe frostbite injury. Patients with severe frostbite were included if they received a post-thrombolytic Technetium 99 (Tc99) bone scan, a Tc99 bone scan without thrombolytic therapy, and/or post-thrombolytic microangiography (MA) study. We included all patients from the years 2006 to 2018 with severe frostbite injury who had received appropriate imaging for diagnosis: Tc99 scan alone (N = 82), microangiography alone (N = 22), and both Tc99 and microangiography (N = 26). The majority of patients received thrombolytic therapy (76.2%), and the average time to thrombolytics was 6.9 hours. Tc99 scans showed strong correlation with amputation level (r = .836, P < .001), and microangiography showed a slightly stronger positive correlation with amputation level (r = .870, P < .001). In the subset who received both Tc99 scan and microangiography (N = 26), we observed significant differences in the mean scores of perfusion deficit (z = 3.20, P < .001). In this subset, a moderate correlation was found between level of perfusion deficit on Tc99 bone scan and amputation level (r = .525, P = .006). A very strong positive correlation was found between the microangiography studies and the amputation level (r = .890, P < .001). These results demonstrate that microangiography is a reliable alternative method of assessing severe frostbite injury and predicting amputation level.
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12
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Manganaro MS, Millet JD, Brown RK, Viglianti BL, Wale DJ, Wong KK. The utility of bone scintigraphy with SPECT/CT in the evaluation and management of frostbite injuries. Br J Radiol 2018; 92:20180545. [PMID: 30359097 DOI: 10.1259/bjr.20180545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE: Frostbite is a localized cold-thermal injury resulting from prolonged exposure of flesh to freezing and near freezing temperatures. The depth and extent of frostbite injuries are not easily assessed, from a clinical standpoint, at the time of injury making it challenging to plan appropriate management and treatment. METHODS: A review of the literature of management of cold-related injuries and retrospective case review of the imaging and clinical course of frostbite injury. RESULTS: Bone scintigraphy with single photon emission computed tomography (SPECT)/CT was performed in the acute and subacute course of frostbite injuries, subsequently leading to earlier definitive management and shorter hospital stay. CONCLUSION: Multiphase technetium-99m-methylenediphosphonate (99mTc-MDP) bone scintigraphy with SPECT/CT can expedite clinical management of frostbite injuries by determining the extent of injury and can accurately predict the level of amputation if needed. ADVANCES IN KNOWLEDGE: SPECT/CT is underutilized at many facilities but can have a profound and immediate impact on clinical management of patients with frostbite when used in combination with physiological bone scan imaging.
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Affiliation(s)
- Matthew S Manganaro
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA
| | - John D Millet
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA
| | - Richard Kj Brown
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA
| | - Benjamin L Viglianti
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA.,2 Nuclear Medicine Service, VA Ann Arbor Healthcare , Ann Arbor, MI , USA
| | - Daniel J Wale
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA.,2 Nuclear Medicine Service, VA Ann Arbor Healthcare , Ann Arbor, MI , USA
| | - Ka Kit Wong
- 1 Departments of Radiology/Nuclear Medicine, University of Michigan Hospital , Ann Arbor, MI , USA
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13
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Frostbite in the United States: An Examination of the National Burn Repository and National Trauma Data Bank. J Burn Care Res 2017; 39:780-785. [DOI: 10.1093/jbcr/irx048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Millet JD, Brown RKJ, Levi B, Kraft CT, Jacobson JA, Gross MD, Wong KK. Frostbite: Spectrum of Imaging Findings and Guidelines for Management. Radiographics 2016; 36:2154-2169. [PMID: 27494386 PMCID: PMC5131839 DOI: 10.1148/rg.2016160045] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/16/2016] [Accepted: 05/25/2016] [Indexed: 02/06/2023]
Abstract
Frostbite is a localized cold thermal injury that results from tissue freezing. Frostbite injuries can have a substantial effect on long-term limb function and mobility if not promptly evaluated and treated. Imaging plays a critical role in initial evaluation of frostbite injuries and in monitoring response to treatment. A multimodality approach involving radiography, digital subtraction angiography (DSA), and/or multiphase bone scintigraphy with hybrid single photon emission computed tomography (SPECT)/computed tomography (CT) is often necessary for optimal guidance of frostbite care. Radiographs serve as an initial survey of the affected limb and may demonstrate characteristic findings, depending on the time course and severity of injury. DSA is used to evaluate perfusion of affected soft tissues and identify potential targets for therapeutic intervention. Angiography-directed thrombolysis plays an essential role in tissue preservation and salvage in deep frostbite injuries. Multiphase bone scintigraphy with technetium 99m-labeled diphosphonate provides valuable information regarding the status of tissue viability after initial treatment. The addition of SPECT/CT to multiphase bone scintigraphy enables precise anatomic localization of the level and depth of tissue necrosis before its appearance at physical examination and can help uncover subtle findings that may remain occult at scintigraphy alone. Multiphase bone scintigraphy with SPECT/CT is the modality of choice for prognostication and planning of definitive surgical care of affected limbs. Appropriate use of imaging to direct frostbite care can help limit the effects that these injuries have on limb function and mobility. ©RSNA, 2016.
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Affiliation(s)
- John D. Millet
- From the Division of Nuclear Medicine (J.D.M., R.K.J.B., M.D.G., K.K.W.) and Division of Musculoskeletal Radiology (J.A.J.), Department of Radiology, and Division of Plastic Surgery, Department of Surgery (B.L., C.T.K.), University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Richard K. J. Brown
- From the Division of Nuclear Medicine (J.D.M., R.K.J.B., M.D.G., K.K.W.) and Division of Musculoskeletal Radiology (J.A.J.), Department of Radiology, and Division of Plastic Surgery, Department of Surgery (B.L., C.T.K.), University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Benjamin Levi
- From the Division of Nuclear Medicine (J.D.M., R.K.J.B., M.D.G., K.K.W.) and Division of Musculoskeletal Radiology (J.A.J.), Department of Radiology, and Division of Plastic Surgery, Department of Surgery (B.L., C.T.K.), University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Casey T. Kraft
- From the Division of Nuclear Medicine (J.D.M., R.K.J.B., M.D.G., K.K.W.) and Division of Musculoskeletal Radiology (J.A.J.), Department of Radiology, and Division of Plastic Surgery, Department of Surgery (B.L., C.T.K.), University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Jon A. Jacobson
- From the Division of Nuclear Medicine (J.D.M., R.K.J.B., M.D.G., K.K.W.) and Division of Musculoskeletal Radiology (J.A.J.), Department of Radiology, and Division of Plastic Surgery, Department of Surgery (B.L., C.T.K.), University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Milton D. Gross
- From the Division of Nuclear Medicine (J.D.M., R.K.J.B., M.D.G., K.K.W.) and Division of Musculoskeletal Radiology (J.A.J.), Department of Radiology, and Division of Plastic Surgery, Department of Surgery (B.L., C.T.K.), University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Ka Kit Wong
- From the Division of Nuclear Medicine (J.D.M., R.K.J.B., M.D.G., K.K.W.) and Division of Musculoskeletal Radiology (J.A.J.), Department of Radiology, and Division of Plastic Surgery, Department of Surgery (B.L., C.T.K.), University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
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