Frostbite Workup

  • Author: H Scott Bjerke, MD, FACS; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Jan 6, 2012
 

Laboratory Studies

  • Laboratory studies of tissue samples, blister fluid, or blood ordinarily do not provide any useful, clinically relevant information in isolated frostbite. Concurrent hypothermia, prolonged exposure with systemic physiologic changes, and prior medical illnesses may exist, however, and laboratory studies in these cases may be helpful.
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Imaging Studies

  • Routine imaging studies early in the diagnosis and treatment of frostbite remain relatively useless in determining the extent and amount of tissue damage. Plain radiographs often demonstrate soft-tissue edema but do not distinguish viable from nonviable tissue.
  • Angiography often shows slowing of blood flow to the distal vasculature, but this too does not correlate well with eventual tissue loss. When a vasodilator is added, this technique can more accurately predict the final pattern of ischemia that will be observed after 2-3 weeks of observation.
  • Technetium-99m (99m Tc) scintigraphy, when used early in the management of frostbite, has been recommended by some authors to aid in directing earlier debridement of nonviable soft tissue. This allows nonviable tissue to be visualized earlier than it is in clinical examination. However, no adequate randomized, prospective trials have confirmed this recommendation. An increased use of scintigraphy in the early and late stages has been reported in the medical literature, but the largest series examined only 20 patients.[23, 24]
  • Similarly, bone scans may help to delineate nonviable bone but should be reserved until microscopic tissue damage has had time to present itself clinically.
  • Magnetic resonance imaging (MRI) has been suggested as a more accurate assessment tool for predicting the limits of nonviable tissue and for guiding early surgical debridement. Clinically, however, none of the techniques discussed here has shown consistent superiority to that of spending 3-4 weeks in watchful waiting for demarcation.
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Other Tests

  • Laser Doppler flowmetry may someday provide a means of predicting the extent of tissue viability in patients with frostbite.
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Contributor Information and Disclosures
Author

H Scott Bjerke, MD, FACS  Clinical Associate Professor, Department of Surgery, University of Missouri-Kansas City School of Medicine; Medical Director of Trauma Services, Research Medical Center; Clinical Professor, Department of Surgery, Kansas City University of Medicine and Biosciences

H Scott Bjerke, MD, FACS is a member of the following medical societies: American Association for the History of Medicine, American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Midwest Surgical Association, National Association of EMS Physicians, Pan-Pacific Surgical Association, Royal Society of Medicine, Southwestern Surgical Congress, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Amit Tevar, MD  Staff Physician, Department of Surgery, Methodist Hospital of Indianapolis and University of Indiana

Amit Tevar, MD is a member of the following medical societies: Indiana State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Burt Cagir, MD, FACS  Assistant Professor of Surgery, State University of New York Upstate Medical University; Consulting Staff, Director of Surgical Research, Robert Packer Hospital; Associate Program Director, Department of Surgery, Guthrie Clinic

Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, and Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David L Morris, MD, PhD, FRACS  Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

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