Protocoled thrombolytic therapy for frostbite improves phalangeal salvage rates.

Document Type

Article

Publication Date

4-2020

Institution/Department

Trauma & Acute Care Surgery

Journal Title

Burns Trauma

MeSH Headings

Amputation, Digit salvage, Frostbite, Thrombolysis, Tissue plasminogen activator

Abstract

Background: Frostbite is a cold injury that has the potential to cause considerable morbidity and long-term disability. Despite the complexity of these patients, diagnostic and treatment practices lack standardization. Thrombolytic therapy has emerged as a promising treatment modality, demonstrating impressive digit salvage rates. We review our experience with thrombolytic therapy for severe upper extremity frostbite.

Methods: Retrospective data on all frostbite patients evaluated at our institution from December 2017 to March 2018 was collected. A subgroup of patients with severe frostbite treated with intra-arterial thrombolytic therapy (IATT) were analysed.

Results: Of the 17 frostbite patients treated at our institution, 14 (82%) were male and the median age was 31 (range: 19-73). Substance misuse was involved in a majority of the cases (58.8%). Five (29.4%) patients with severe frostbite met inclusion criteria for IATT and the remaining patients were treated conservatively. Angiography demonstrated a 74.5% improvement in perfusion after tissue plasminogen activator thrombolysis. When comparing phalanges at risk on initial angiography to phalanges undergoing amputation, the phalangeal salvage rate was 83.3% and the digit salvage rate was 80%. Complications associated with IATT included groin hematoma, pseudoaneurysm and retroperitoneal hematoma.

Conclusions: Thrombolytic therapy has the potential to greatly improve limb salvage and functional recovery after severe frostbite when treated at an institution that can offer comprehensive, protocoled thrombolytic therapy. A multi-center prospective study is warranted to elucidate the optimal treatment strategy in severe frostbite.

ISSN

2321-3868

First Page

008

Last Page

008

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