No abstract

F rostbite can occur in cold climates, affecting a range of patients from those who are homeless or unwell, to athletes in extreme sports events. The impact of severe frostbite can be debilitating. Frostbite injuries are a result of an initial extracellular freezing injury followed by a reperfusion injury due to vasoconstriction and microthrombosis in affected tissues. 1 The severity of injuries can range from mild to severe. A grading system developed by Cauchy and colleagues 2,3 describes grade 1 to grade 4 frostbite. The higher the grade, the more proximal the cyanotic changes in the digits, and the higher the amputation rate.The foundations of frostbite treatment have included rapid rewarming 4 and antithromboxane agents such as aloe vera for topical use and ibuprofen. 5 More recently, vasodilators and thrombolytics have been promoted to address the reperfusion injury caused by vasoconstriction and thrombosis. Beginning in the 1990s, a growing body of evidence has popularized the use of iloprost in frostbite, first in Europe and now in Canada. 6,11,15,16,21,24,27 Iloprost, a synthetic prostacyclin analogue, is a potent vasodilator that inhibits platelet aggregation and enhances fibrinolytic activity by releasing endogenous tissue plasminogen activator. 29 To our knowledge, there is a single randomized controlled trial published to date showing the benefit of iloprost combined to alteplase and heparin. 11 We developed and implemented a frostbite treatment protocol and preprinted orders at our institution based on the best available evidence in February 2015. The aim of the present study was to describe the demographic characteristics, treatment course and clinical outcomes of patients treated as per our protocol.