Frostbite: Spectrum of Imaging Findings and Guidelines for Management

Millet, John D.; Brown, Richard K.; Levi, Benjamin; Kraft, Casey T.; Jacobson, Jon A.; Gross, Milton D.; Wong, Ka Kit

doi:10.1148/rg.2016160045

Cited by 50 publications

(74 citation statements)

References 54 publications

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“…8,10,11 Single photon emission computed tomography/standard computed tomography (SPECT/ CT) has been found to add value to define finer anatomic details before definitive surgical care of frostbite. 11 There have been case reports of magnetic resonance imaging and magnetic resonance angiography use in assessment of tissue necrosis and viability that permitted earlier surgical intervention. 12 The first real advance in frostbite treatment in decades was the use of tPA in a few case reports and then clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Severe Frostbite in Extreme Altitude Climbers—The Kathmandu Iloprost Experience

Pandey¹,

Vadlamudi²,

Pradhan³

et al. 2018

Wilderness & Environmental Medicine

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Severe frostbite occurs frequently at extreme altitude in the Himalayas, often resulting in amputations. Recent advances in treatment of frostbite injuries with either intravenous or intra-arterial tissue plasminogen activator, or with iloprost, have improved outcomes in frostbite injuries, but only if the patient has access to these within 24 to 48 h postinjury, and ideally even sooner. Frostbitten Himalayan climbers are seldom able to reach medical care in this time frame. We wished to see if delayed iloprost use (up to 72 h) would help reduce tissue loss in grade 3 to 4 frostbite. In a series of 5 consecutive climbers with severe frostbite in whom we used iloprost, 4 of whom received treatment between 48 and 72 h from injury, 2 had excellent results with minimal tissue loss, and 2 had good results with tissue loss less than expected. The 1 patient with a poor outcome likely experienced a freeze-thaw-refreeze injury. This small series suggests that iloprost can be beneficial for severe frostbite, even after the standard 48-h window and perhaps for up to 72 h.

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Section: Discussionmentioning

confidence: 99%

Case Report: Severe Frostbite in Extreme Altitude Climbers—The Kathmandu Iloprost Experience

Pandey¹,

Vadlamudi²,

Pradhan³

et al. 2018

Wilderness & Environmental Medicine

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“…Imaging forms an important part of the initial management for assessment of prognosis and likelihood of distal necrosis. Although many different imaging modalities have been suggested, angiography and technetium 99 bone scanning are the most useful prognostically [15,27,28].…”

Section: Discussionmentioning

confidence: 99%

The evolution of the Helsinki frostbite management protocol

Lindford

Valtonen

Hult

et al. 2017

Burns

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“…Kraft et al used single photon emission CT/CT for 7 patients with frostbite and found it improved surgical planning for deep frostbite injuries by enabling early and precise anatomic localization of nonviable tissues. 65,66 If available, appropriate imaging should be used to assess tissue viability and guide timing and extent of amputation. Recommendation Grade: 1C.…”

Section: Imagingmentioning

confidence: 99%

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update

McIntosh

Freer

Grissom

et al. 2019

Wilderness & Environmental Medicine

102

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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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Frostbite: Spectrum of Imaging Findings and Guidelines for Management

Abstract: Abbreviations: DSA = digital subtraction angiography, MDP = methylene diphosphonate, tPA = tissue plasminogen activator

Cited by 50 publications

References 54 publications

Case Report: Severe Frostbite in Extreme Altitude Climbers—The Kathmandu Iloprost Experience

Case Report: Severe Frostbite in Extreme Altitude Climbers—The Kathmandu Iloprost Experience

The evolution of the Helsinki frostbite management protocol

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update

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