Frostbite

Synonyms. Dermatitis congelationis, congelatio.

    

When the soft parts are frozen and locally deprived of blood supply, the affection is termed "frostbite." The ears, nose, cheeks, fingers, and toes are most often affected. Various degrees of destruction similar to those caused by burns are encountered: (1) erythema and edema; (2) blisters and bullae; (3) superficial gangrene; (4) gangrene of skin and subcutaneous tissue; (5) gangrene of a whole part of an extremity or other parts of the body, especially the ears; (6) injury to muscles, tendons, periosteum, bone, and nerves without or with accompanying lesions of the skin; (7) chronic

relapsing lesions of the skin—e.g., chilblains and other forms of erythrocyanosis.

       Frostbite or immersion foot (trench foot, shelter foot) may develop after long mild ground exposure or in a few minutes from high altitude exposure, sometimes due to carelessness of flyers in adjusting their electrically heated clothing.

       Treatment. Early treatment of frostbite before swelling develops should consist of covering the part with clothing or with the warm hand or other body surface until circulation is improved. Any rubbing of the affected part should be avoided, but gentle massage of proximal portions of the extremity which are not numb may be helpful.

       After swelling and hyperemia have developed, the patient should be kept in bed with the affected limb slightly flexed, elevated and at rest. Cooling of the limb by exposure to air at room temperature may relieve pain and conserve tissue damage. Protection by a cradle and further cooling by ice bags placed outside the cradle may be desirable. Heparin, in doses of 100 mg. four times a day, should be started at once and continued for a week or ten days, to protect against thrombosis and gangrene. Papaverine and hexamethonium are given to reduce vasospasm. Penicillin or other antibiotics should be given as a prophylactic measure against infection.

       The treatment of immersion foot is strict bed rest, and elevation, with asepsis. Bathroom privileges are denied. The limb is protected by a cradle and is cooled at room temperature to relieve the pain.

       Wet dressings with water at 41° F. ( 5° C.) to 58° F. (10° C.) are a first aid. Further treatment along the lines recommended for frostbite may be indicated. Some patients are also victims of exposure and require blood plasma or serum albumin.

       Anesthetic infiltration of the lumbar and stellate sympathetic may be indicated in obdurate, severe cases of vasospasm. Relief is immediate and the infiltrations are repeated on the next two days.