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Abstract
Frostbite is tissue damage caused by freezing temperatures and constitutes an important cause of morbidity in cold climate zones and high altitude. The direct effects of sub-zero temperatures lead to tissue freezing, electrolyte shifts and pH alterations, microvascular damage, and eventually to cell death. Upon rewarming, inflammatory reperfusion injury and thrombosis may lead to further tissue damage. Several studies and various case reports show that many patients suffer from long-term sequelae such as vasomotor disturbances (associated with susceptibility to refreezing), and neuropathic and nociceptive pain, as well as damage to skeletal structures. There are still many uncertainties regarding the pathophysiology of these sequelae. It has been shown that the transient receptor potential channel (TRP) family plays a role in cold allodynia. Botulinum Toxin type A (BTX-A) injections have been reported to be beneficial in vasomotor and neuropathic disturbances secondary to frostbite. Epidural sympathetic block has been used for short-term treatment of frostbite induced chronic pain. Furthermore, amitriptyline, gabapentinoids, and duloxetine may have some benefits. Frostbite arthritis clinically resembles regular osteoarthritis. In children there is a risk of epiphyseal cartilage damage leading to bone deformities. Despite some promising therapeutic concepts, the scarcity of data on frostbite long-term sequelae in the literature indicates the need of more in-depth studies of this pathology in all its aspects.
Highlights
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.Licensee MDPI, Basel, Switzerland.Frostbite is defined as tissue-freezing caused by heat loss sufficient to cause ice-crystal formation in superficial or deep tissue [1]
The severity of frostbite injury depends on environmental temperature, wind chill factor, and length of exposure [2]
6 studies were excluded, because they did not report on long-term sequelae after frostbite injury
Summary
Frostbite is defined as tissue-freezing caused by heat loss sufficient to cause ice-crystal formation in superficial or deep tissue [1]. The severity of frostbite injury depends on environmental temperature, wind chill factor, and length of exposure [2]. Due to their exposed and peripheral anatomical position, frostbite mainly affects distal upper and lower extremities, ears, nose, and cheeks [3]. There is a wide spectrum of clinical presentation of frostbites, ranging from injuries that resolve completely without any consequences, to injuries that result in major limb amputation [4]. Even without significant tissue loss, patients may suffer from long-term sequelae after having suffered a frostbite injury
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