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Frostbite - the body's response to local exposure to low ambient temperatures.

Predisposing factors

Weather conditions

- low air temperature,

- high humidity,

- the wind.

Mechanical impairment of blood circulation

- tight shoes, clothes.

Decreased local tissue resistance

- vascular diseases,

- trophic changes

- relative immobility,

- excessive bending,

Reducing the overall body resistance.

- shock and blood loss,

- tiredness, exhaustion,

- hunger

- infectious diseases,

- hypoxia leading to mental disorders,

- alcohol intoxication.

Frostbite periods

• Pre-reactive period (latent) - the time from the onset of exposure to low temperatures, to the restoration of tissue temperature.

• Reactive period - time since the restoration of blood circulation.

- Early reactive period (up to 7 days)

- Late jet period


The duration of this period and the degree of decrease in tissue temperature are the leading factors of pathological changes in the subsequent reactive period.

Clinical signs

- Complaints of pain, numbness, paresthesia in the form of vague crawling sensations in an injured part of the body, decreased sensitivity.

- The skin is pale, cold.

- Reduced pain and tactile sensitivity.

- The disappearance of the pulse in the peripheral arteries.

- Glaciation is possible.

To judge the depth of damage during this period is not possible.

Treatment principle

- Not forced warming in water (temperature from 20 ° C gradually over an hour, increasing it to 37 ° C) with 0.1% potassium permanganate solution.

- Infusion of plasma substitutes heated to 36 * C (reopigluglukin).

- Introduction of anticoagulants of direct and indirect action (heparin, fenilin).

- Introduction of antiplatelet agents (aspirin, trental, chimes).

- Introduction of vasodilating drugs (no-spa, nicotinic acid, theonikol)

- Introduction of vitamins of group B, C, PP (askorutin).

Reactive period

Phase I - inflammation (up to 7 days)

Clinical signs

• Pain, with extensive lesions and plasma loss lead to the development of hypovolemic shock.

• Hyperemia of the skin with a bluish tinge at the site of injury. Edema with deep frostbite significantly exceeds the damage site, causes secondary impairment of microcirculation and aggravates tissue hypoxia.

• Hyperthermia of the skin.

• Disruption of function (movements) by 3-4 days.

• Intoxication (fever, headache, nausea).

Phase II - development of necrosis and its delimitation (from day 7)

Clinical signs

Clinical signs depend on the degree of impairment of regional blood circulation.
This phase clearly shows the depth of the lesion, which is characterized by degrees of gravity.

Degrees of severity:

Grade I - the skin is purple-cyanotic, edema. The process is reversible.

Grade II - on a purple-cyanotic background bubbles containing serous fluid. The bottom of the bubbles is bright red, the bottom palpation is sharply painful.

Grade III - against the background of a purple-cyanotic skin bubbles containing hemorrhagic fluid. The bottom of the bladder is purple, palpation painless.

If, in the absence of blisters, there is a sharp swelling and loss of sensitivity within 48 hours, then the affected person has a 3 degree frostbite.

Stage IV - gangrene, the death of all tissues. External manifestations are similar to frostbite III degree.

Reception of Billroth: if after a day of the reactive period, complete deep anesthesia remains within the same limits and at the same time, not blood but a hemolyzed fluid is released from the injections at the anesthesia sites, the anesthesia areas are considered dead, and their edges are a future demarcation zone.

Frostbite 1-II degree - superficial

Frostbite Grade IV - Deep

Local manifestations of frostbite are accompanied by intoxication, the degree of which depends on the volume and depth of the lesion. When joining the infection may develop sepsis.

Phase III - scarring and epithelialization

Begins after rejection of necrosis (independently or by surgery).

The outcome of frostbite

P degree - epithelialization.

W degree - scarring.

IV degree - dry or wet gangrene.

The principle of treatment of frostbite in the reactive period

General treatment

• Antibacterial therapy

• detoxification therapy

• Anti-inflammatory therapy

• Normalization of microcirculation:

infusion of reopoliglyukin, antispasmodics, anticoagulants, antiplatelet agents,

• Vitamin therapy (vitamins C, B1, B6, P, nicotinic acid),

• Symptomatic therapy

• Prevention of tetanus

Local treatment

Frostbite I - II degree is treated with conservative methods (wet-drying dressings, dressings with hydrophilic ointments, UHF).

In case of frostbite of the III degree, active surgical tactics are used: transfer of wet necrosis to dry, followed by necrectomy and skin grafting (see treatment of thermal burns).

When frostbite IV degree spend economical amputations:

early on 5 - 7 days,

later - after the formation of a clear demarcation.
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