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In the clinical course of frostbite, two periods are clearly distinguished: before reheating - pre-reactive (or hidden) and after reheating - reactive. Direct cell damage occurs in the reactive period. Therefore, only after an increase in interstitial temperature and the completion of pathophysiological changes can we judge the degree of frostbite. The process of tissue death sometimes takes up to 5 - 7 days, after which it seems possible to finally judge the depth of frostbite.

The clinical picture of the pre-reactive period is rather poor in symptoms. The earliest symptoms of developing frostbite are numbness, paresthesia such as "crawling creeps," then pain and a feeling of stiffness in the affected limb appear. On examination, pallor of the skin, sometimes cyanosis, is noted; limb to the touch cold; tactile and pain sensitivity are reduced; edema, as a rule, is not; sometimes there is no pulsation of arteries on the feet.

The first sign of a reactive period is the appearance of tissue edema, followed by pain and changes in the skin corresponding to the depth of the lesion.

The classification of frostbites accepted in our country is based on a four-degree division, proposed in 1940 by T. Ya. Aryev. It is based on the division of lesions into superficial (first and second degree) and deep (third and fourth degree).

FROZEN FIRST DEGREE develops with a short exposure to cold. Pallor of the skin during warming is replaced by hyperemia. Tactile and pain sensitivity, as with burns, saved and even increased. The movements in the fingers and feet are active. There is moderate edema within the boundaries of hyperemia. Sometimes cyanosis or marbled color of the skin is observed, which is more often with deeper lesions.

FREEZING SECOND DEGREE. The most characteristic is the formation of blisters filled with a clear liquid, as with burns. Prior to this, the skin is hyperemic, with a bluish tint. Edema, as well as during frostbite of the first degree, is insignificant. Bubbles usually form on the first day after an injury; less often, the appearance of bubbles during the second day can be observed. If the bubbles arose at a later date, and their contents have a dark color, then this usually indicates a deeper lesion.
The healing of such frostbite occurs without the development of granulation and scarring. Nails fall off, but then grow back.

FROZENING THE THIRD DEGREE The bubbles that appear early are filled with bloody contents, the bottom of the bubbles is dark cherry or bluish in color. Before their formation, the skin has a crimson-cyanotic color and is cold to the touch, in contrast to damage of 1-2 degrees. Damaged areas are not sensitive to chemical (ethyl alcohol) and pain irritants; tactile sensitivity can be maintained, but significantly reduced. With such a lesion, necrosis captures the entire dermis to subcutaneous fat, as a result of which their healing occurs with the formation of rough scars. Nails, as a rule, are not restored. The absence of bubbles in the presence of a sharp edema and loss of all types of sensitivity within 48 hours or more is an unfavorable prognostic sign and indicates a fourth degree of frostbite.

Frostbite FOURTH DEGREE. The border of the lesion passes at the level of bones and joints. In the first hours of the reactive period, the skin of the damaged area is sharply cyanotic, sometimes with a marble tint. The temperature of the skin is significantly reduced. The development of edema begins 1-2 hours after an increase in interstitial temperature. Swelling increases within 1-2 days and increases towards the proximal extremities. Subsequently, mummification or wet gangrene of the fingers or limbs develops.

In the affected area with deep frostbite, four zones are distinguished from the periphery to the center:

1) total necrosis - all tissues of this zone by the time normalization of interstitial temperature is already necrotic;

2) irreversible degenerative processes - the tissues are in a necrobiotic state, and as a result of severe vascular disorders and toxemia, they become dead in the coming days after an injury;

3) reversible degenerative processes - with timely proper treatment, tissue necrosis of this zone can be prevented;

4) ascending pathological processes - in this zone osteoporosis, neuritis, endarteritis subsequently develop.
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    On the issue of tactics of first aid and treatment of frostbite in the pre-reactive period, there are two points of view. The first, older, theory of "forced warming" is based on the fact that the sooner it is possible to stop the action of a damaging factor (cold) on the tissue, the better the treatment results. The second, more modern, concept of "warming from the inside" comes from
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  6. Frostbite
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  7. Frostbite
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  8. Frostbite
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  9. Frostbite
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  10. Frostbite
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  12. Frostbite
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