Title

Protocoled thrombolytic therapy for frostbite improves phalangeal salvage rates.

Authors

Rosemary Elizabeth Paine, Maine Medical CenterFollow
Elizabeth Noel Turner, Maine Medical CenterFollow
Daniel Kloda, Maine Medical CenterFollow
Carolyne Falank, Maine Medical CenterFollow
Bruce Chung, Maine Medical CenterFollow
Damien Carter, Maine Medical CenterFollow

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

Recommended Citation

Paine RE, Turner EN, Kloda D, Falank C, Chung B, Carter DW. Protocoled thrombolytic therapy for frostbite improves phalangeal salvage rates. Burns Trauma. 2020;8:tkaa008. Published 2020 Apr 10. doi:10.1093/burnst/tkaa008