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Avoidance of premature debridement in frostbite is essential. Surgical debridement or early amputation prior to clear demarcation and mummification greatly increases the risk of infection and will result in increased tissue loss. Demarcation of nonviable tissue may take two to three months and early, active physiotherapy and functional splinting should be underway both before and as an adjunct to eventual operation.

For patients who develop vasospastic syndromes as a sequel to frostbite, late regional sympathectomy has been proposed to treat chronic symptoms. In addition, late distal sympathectomy at the level of the digital arteries may be useful for relief of debilitating vasospastic states with pain, cold sensitivity, and trophic changes.

Systemic anticoagulation is not useful in frostbite injury. The intrinsic muscles of the hand may be particularly sensitive to severe frostbite; varying degrees of fibrosis of the muscle bellies have been attributed to local ischemia. In extreme cases, late release of fibrosed muscles and joint contractures may be required but this is not considered until a rigorous rehabilitation program is completed.

References

2/1. Flatt AE: Digital artery sympathectomy. J Hand Surg 5:550-556, 1980

2/2. House JH, Fidler MO: Frostbite of the hand, in Green DP (ed): Operative Hand Surgery. New York, Churchill Livingstone, 1993, pp 2033-2041

3/2. Murray JF: Cold, chemical, irradiation injuries, in McCarthy JG(ed): Plastic Surgery. Philadelphia, WB Saunders Co, 1990, pp 5431-5451