Frostbite (tissue damage from cold)

Description Occurs when the ski...

Description

Occurs when the skin and underlying tissue freezes due to being exposed to extreme cold. Exposure to the cold first causes frost-nip, which is reversible skin irritation. If rewarming doesn't occur frost-nip can progress to frostbite. Frostbite affects the fingers, toes and face, and tends to occur in those who do not feel the effects of frost-nip or those who cannot or will not remove themselves from the cold. The disorder is more often associated with alcoholism, psychiatric illness, diabetes, smokers and previous frostbite.

Symptoms

Initially pins and needles followed by numbness, throbbing, and aching. Later sensation disappears secondary to death of the nerves. The skin appears hard and pale. Severe frostbitten skin can have blisters, black discoloration (represents gangrene), and damage to the underlying bones, muscles, and tendons.

Tests

Common tests used for diagnosis and treatment

Workup:
A history and physical exam will be done. Tests to determine the extent of the damage may be performed.

Tests:
X-ray

Specialists:
Orthopedic Surgery, Podiatry

Treatment

Remove the patient from the cold and protect the frostbitten areas from further damage. If there is a chance of re-freezing do not thaw the injured area. Sterile dressings should be applied to the affected areas. If possible do not use the injured area. Rewarming can be done soaking the frostbitten area in warm water (104 to 108 degrees Fahrenheit). Severe burning pain, swelling, and color changes may occur during warming. Warming is complete when the skin is soft and sensation returns. Apply sterile dressings after thawing and separate the fingers or toes with dressing material. Treatment in the hospital consists of continued rewarming, dressings, removal of dead tissue (debridement) and surgery. Removal of dead tissue is not done aggressively early since tissue that initially looks dead can sometimes be saved with time and treatment.