Protocoled thrombolytic therapy for frostbite improves phalangeal salvage rates. Issue 1 (10th April 2020)

• Record Type: Journal Article
• Authors: Paine, Rosemary Elizabeth; Turner, Elizabeth Noel; Kloda, Daniel; Falank, Carolyne; Chung, Bruce; Carter, Damien Wilson
• Is Part Of: Burns and trauma. Volume 8:Issue 1(2020)
• Publication Date: 2020-04-10
• Subjects: Frostbite -- Tissue plasminogen activator -- Amputation -- Digit salvage -- Thrombolysis; Burns and scalds -- Periodicals; Wounds and injuries -- Periodicals; 617.11
• DOI: 10.1093/burnst/tkaa008
• Languages: English
• ISSNs: 2321-3876

Abstract

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.