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Abstract

Purpose:

Thrombolytic treatment with tissue plasminogen activator (tPA) in the treatment of severe frostbite injury has been shown to improve clinical outcomes. This study retrospectively evaluated initial zone of injury and amputation level (change in level of injury) in all patients with severe frostbite treated at out institution over a 2 year period.

Methods:

A retrospective review was performed on 199 patients who presented for upper-extremity frostbite over a two year period. Eligible patients, who presented within 24 hours of injury, underwent angiography and treatment with thrombolytic therapy in addition to standard medical care. Injured digits were then classified on initial level of injury and level of amputation. Outcomes of patients treated with tPA were compared to patients ineligible for tPA treatment.

Results:

Twenty-one patients (185 digits) had severe (Grade III/IV) frostbite injury, defined as initial lesion at level or proximal to proximal phalanx or presence of hemorrhagic blisters. There were 15 males and 6 females, with an average age of 57. 5 years. Eight patients were treated with tPA (75 digits) and 13 patients were treated conservatively (110 digits). Involved thumbs (33 digits) were analyzed separately. Angiography demonstrated subjectively improved blood flow in all patients treated with tPA. There were no complications related to tPA treatment. Non-thumb fingers treated with tPA and those treated conservatively had a 1.83 and 0.04 (p<0.0001) mean improvement in finger zone of injury respectively. Thumbs treated with tPA and those treated conservatively had a 2.0 and 0.32 (p<0.0001) mean improvement in zone of injury respectively.

Conclusions:

Thrombolytic therapy after severe frostbite improves arterial blood flow and results in a more distal amputation level. As a result of our study we recommend angiography and thrombolytic therapy for all eligible patient who present with severe frostbite.