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Frostbite Treatment & Management

  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Dirk M Elston, MD  more...
Updated: Feb 26, 2016

Approach Considerations

The goal of frostbite treatment is to salvage as much tissue as possible, to achieve maximal return of function, and to prevent complications.[38] If treating personnel are unfamiliar with the management of frostbite and its sequelae, transfer of the patient to another facility should be considered. In some settings, burn units have particular expertise in managing severe frostbite injuries. In one report, 29% of homeless patients admitted to a burn unit were admitted for frostbite.[39] Therefore, transfer to a facility with a burn unit may be an option.

Be sure to correct the ABCs (A irway, B reathing, and C irculation) and life-threatening conditions before treating frostbite. Make sure that the frostbitten area does not refreeze. Rewarm the frostbitten area as quickly as possible to salvage as much tissue and function as possible. The use of circulating water at 40-42°C is common. Do not allow the water to get too hot or too cold. Avoid premature termination of the rewarming process. Remember to treat pain associated with rewarming.

Avoid early amputation until after the nonviable tissue is clearly demarcated. Inform patients that the injury site is more prone to recurrent damage when exposed to even moderate changes in environmental temperature.

Consider obtaining a photographic record on admission, 24 hours after admission, and serially every 2-3 days until discharge.

The management of frostbite itself may be divided into 3 phases: field management, rewarming, and postrewarming management.[24]


Field Management

The first step in the management of frostbite is prevention. The US Army decreased the incidence of cold injury of all types in soldiers from 1985-1999. This was accomplished through training, education, and improved clothing.[25] When suspected frostbite does occur, transport to a trauma or burn center becomes a priority. Field rewarming should be started only if the time to arrival at a definitive care center exceeds 2 hours.

As a general principle, always address the ABCs and treat any life-threatening conditions (eg, hypothermia) first. Correct any systemic hypothermia to a core temperature of 34°C before treating the frostbite.

Remove the patient from cold. Replace wet and constrictive clothing with dry loose clothing. Remove jewelry from the affected area.  Dress the extremity in a manner that minimizes mechanical trauma.

Rewarm the frostbitten area if no danger of refreezing is present. However, rewarming should be avoided if it cannot be maintained (freeze-thaw-freeze cycle). Walking on frozen frostbitten areas and risking tissue chipping and fracture is considered better than thawing and refreezing. Reports from Canada show that forced-air rewarming with portable units can be used effectively to warm victims of hypothermia and frostbite in the field and during transport to a regional medical center.[40]



Rapid rewarming is the single most effective therapy for frostbite.[41] Variations on the original work of McCauley et al are used at most centers experienced in the management of the frostbite patient.[28] This includes admission of all frostbite patients to a specialty unit, if possible. Consider obtaining photographic records on admission, at 24 hours, and serially every 2-3 days until discharge.

On admission, rapidly rewarm the affected area in circulating water (ie, a whirlpool bath) at 37-39°C. The circulation of water allows a constant temperature to be applied to the affected area. Warming is continued for 15-30 minutes or until thawing is, by clinical assessment, complete (ie, when the distal area of the extremity is flushed, soft, and pliable). The addition of an antiseptic solution such as povidone-iodine or chlorhexidine to the bath may be beneficial.

Avoid inadvertent slow rewarming or overheating. Encourage active gentle motion of the frostbitten area during the rewarming. Constantly monitor water temperature. Thawing takes about 20-40 minutes for superficial injuries and as long as 1 hour for deep injuries.

The most common error in this stage of treatment is premature termination of the rewarming process because of reperfusion pain. Mechanical trauma (massaging or rubbing with ice or by hand) and rewarming at higher temperatures and for longer periods of time are detrimental to preserving viable tissue and should be avoided. Direct dry heating using fire or a heater can lead to burns secondary to loss of temperature sensation and so should be avoided.

Partial thawing and refreezing generate more damage than does prolonged freezing alone, through the release of multiple inflammatory mediators. In patients who experience a refreezing injury of thawed areas, rewarming should be delayed until it can be maintained.


Postrewarming Management

Once the skin is thawed, protect the area from further injury and reexposure to cold. Elevate the area and splint the extremity. Sterile, nonadherent dressings should be applied.  They should be changed  2-4 times a day and local wound care performed. The injured area should be closely monitored for signs of infection.

Aspiration of clear blisters to prevent thromboxane- and prostaglandin-mediated tissue damage may make theoretical sense but is not supported by strong evidence.  In order to avoid desiccation and infection of underlying deep layers, do not debride hemorrhagic blisters. Manage fractures and dislocations conservatively until thawing is complete.

Carry out daily hydrotherapy for 30-45 min at 40°C.


Pharmacologic Therapy

Analgesics (eg, ibuprofen and morphine) for pain relief are indicated during and after rewarming.

Apply topical aloe vera cream to all frostbitten areas every 6 hours to inhibit the arachidonic cascade, especially thromboxane synthesis.

Administer tetanus prophylaxis (tetanus toxoid or immune globulin).

Antibacterial prophylaxis is generally not recommended. Frostbite infections tend to involve staphylococci, streptococci, enterococci, and Pseudomonas pathogens. If infection develops, oral or parenteral antibiotics should be administered based on local sensitivities.

While supporting evidence is limited, infusion of low-molecular-weight dextran may be beneficial by preventing erythrocyte clumping in cold-injured blood vessels, with an associated decrease in tissue necrosis.[42]

Growing evidence supports the use of intravenous or intra-arterial thrombolysis with tissue plasminogen activator (tPA) in the management of frostbite. When administered within 24 hours of thawing, it has been shown to decrease amputation rates. It is generally administered as a bolus followed by an infusion, along with heparin.[43] Thrombolysis should only be performed after a careful risk-benefit analysis and in a setting where the patient can be closely monitored for complications. Some protocols include the addition of the vasodilator iloprost.[16, 44, 45, 46]

Other ancillary modalities that may be helpful but have not been tested in well-controlled human trials include the following:

  • Buflomedil (an alpha-blocker) to increase peripheral blood flow
  • Hyperbaric oxygen [47, 48]
  • Subatmospheric pressure therapy (anecdotal) [49]
  • Pentoxifylline [50]
  • Vitamin C
  • Superoxide dismutase
  • Nifedipine

Surgical Removal of Nonviable Tissue

It may take weeks to months for frostbitten tissue to be declared viable. The affected area generally heals or mummifies without surgery. Lower-extremity involvement, infection, and delay in seeking medical attention are associated with an increased likelihood that operative therapy will be necessary.

Early surgery usually is contraindicated in frostbite, because of the time the nonviable tissue takes to demarcate. Older series show that performing debridement earlier than 2-3 weeks after warming significantly increases the amount of viable tissue removed and is harmful to the patient, resulting in increased amputation rate, mortality, and morbidity. The only indication for early surgical intervention is postthaw compartment syndrome warranting fasciotomy.

Whereas some advocate an aggressive approach, with bone and tissue scanning employed to identify nonviable tissue at 10 days, this is not considered routine or standard of care. Caregivers are cautioned to wait for demarcation of clearly necrotic tissue before surgical intervention. This usually takes about 3-4 weeks but may take longer. Commonly accepted indications for surgical debridement at 3-4 weeks include gangrene and clearly necrotic or nonfunctional tissue.

Wet gangrene is treated by urgent surgical excision of the affected area.

Standard surgical techniques are used for excision and debridement after tissue demarcation. Amputation skin grafting and bone and tissue coverage, potentially with muscle flaps, may be considered.[51]

Skin grafting may be required. Escharotomy may be appropriate if the eschar is preventing circulation or limb motion. Fasciotomy may be appropriate if elevated compartment pressure occurs. Escharotomy and fasciotomy have no proven prophylactic role in the management of frostbite. Ischemic injury in frostbite is most often caused by vascular compromise from thrombosis and not by compression from edematous tissue, making decompression unnecessary. Only when proven compartment syndrome is present is decompression needed.

Because of the extreme difficulty in differentiating viable tissue from nonviable tissue in the first few weeks after frostbite injury, amputation surgery is best avoided until complete demarcation and separation of gangrenous tissue occurs. This process normally takes 6-8 weeks. Consider early amputation if liquefaction, moist gangrene, or infection develops in the frostbitten area.

Early surgical sympathectomy was been proposed in the past to reduce vasoconstriction-associated tissue loss.  However, evidence to support this practice is limited or lacking.  It is therefore not recommended. 

Pressure dressings, occlusive dressings, and elastic wraps will decrease tissue perfusion and increase the risk of tissue loss. The presence of a concomitant injury with active bleeding requires direct pressure over the bleeding site, but caregivers should be aware that such actions are performed as life-saving measures and can result in increased morbidity.

In a report of a single patient treated with vacuum-assisted closure (VAC) therapy, Poulakidas et al described improved tissue salvage and early reepithelialization, suggesting that VAC may be of some benefit in the management of frostbite-induced tissue damage.[49]


Further Inpatient Care

Because the initial insult is not predictive of the final outcome, most patients with frostbite must be hospitalized for 24-48 hours to assess the extent of injury. The mean length of hospital stay for all levels of frostbite ranges from 8.5-33.2 days.

Daily wound care includes bivalving of any constricting eschars. Most skin grafting and amputations occur during weeks 3 or 4 after the injury.

Use hydrotherapy (ie, whirlpool bath filled with lukewarm water [40°C] and surgical soap) for 30-45 minutes twice daily until the eschar sloughs off. This measure reduces infection, facilitates debridement, and softens the eschar.

Avoid smoking, because nicotine causes vasoconstriction.[27] No restriction on diet is required, but a high-protein, high-calorie diet is suggested to promote healing.

Rest the injured area initially. Elevation helps to reduce swelling. Place cotton pledgets between frostbitten digits to decrease tissue maceration. Perform physical therapy to increase flexibility and dexterity once the injury begins to heal. Encourage active motion of the affected part as soon as possible.



Prevention is the key to decreasing the number and overall morbidity of frostbite injuries. Frostbite prevention involves having a working knowledge of the environmental risks and hazards of outdoor activities in colder climates, using adequately protective clothing against cold and wind, and having a basic field knowledge of treatment options for frostbite. In conditions conducive to frostbite, patients should be advised to do the following:

  • Seek shelter from wind and cold
  • Wear several layers of light, loose clothing, which traps air for insulation yet provides for adequate insulation; such layering provides better protection than a single bulky layer of heavy clothing
  • Wear mittens instead of gloves because they decrease surface area exposure to the cold; if mittens are removed to allow use of the fingers, wear lightweight gloves under the mittens for protection
  • Wear at least 2 pairs of socks
  • Cover the face and head
  • Choose fabrics suited for the cold (eg, fleece, polypropylene, wool)
  • Avoid restrictive and tight clothing that reduces peripheral circulation
  • Avoid getting clothing wet
  • Avoid remaining in the same position for prolonged periods
  • Check skin every 10-20 minutes for frostbite
  • Avoid smoking, because it causes peripheral vasoconstriction

When frostbite injuries do occur, expeditious treatment at a specialty center results in the least amount of permanent disability and tissue loss.



Frostbite treatment is a multidisciplinary process and may involve the following specialists:

  • Emergency physician to stabilize the patient
  • Hospitalist to provide inpatient medical treatment
  • Surgeon to provide surgical care
  • Physical therapist to provide rehabilitation
  • Psychiatrist to help the patient cope with any permanent disability

Early surgical consultation for amputation is rarely needed. Surgical consultation is appropriate for guiding long-term management, including debridement for infections that do not respond to conservative management or for skin grafting.


Long-Term Monitoring

Long-term surgical management includes the following options:

  • Debridement of demarcated nonviable tissue - The demarcation process usually takes 1-3 months from the time of initial exposure [24]
  • Skin grafting
  • Reconstruction of nose, ears, fingers, and toes
  • Referral for physical rehabilitation

Counsel patients that the frostbitten area is more vulnerable to future heat and cold injury. Encourage patients to undergo active physical therapy.

Further outpatient care includes wound management, analgesia, and avoiding re-exposure to the cold. The choice of outpatient medications is dictated by the patient’s hospital course and may include antibiotics, analgesics, and ibuprofen.

Contributor Information and Disclosures

C Crawford Mechem, MD, MS, FACEP Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department

C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.


David Cheng, MD Associate Professor of Emergency Medicine, Education Director, Associate Emergency Medicine Residency Director, Case Medical Center

David Cheng, MD is a member of the following medical societies: American College of Emergency Physicians, International Society for Mountain Medicine, Council of Emergency Medicine Residency Directors, American Heart Association, National Association of EMS Physicians, Society for Academic Emergency Medicine, Society of Critical Care Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Ramy Yakobi, MD, MBA Medical Director, Department of Emergency Medicine, Beth Israel Medical Center

Ramy Yakobi, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Tonya M Thompson, MD, MA Assistant Professor, Departments of Pediatrics and Emergency Medicine, Associate Fellowship Director, Pediatric Emergency Medicine Fellowship, Associate Medical Director, The PULSE Simulation Center, Arkansas Children's Hospital, University of Arkansas for Medical Sciences College of Medicine

Tonya M Thompson, MD, MA is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Womens Association, Phi Beta Kappa, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.


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 Associate Professor, Department of Surgery, Indiana University School of Medicine

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, andWilderness Medical Society

Disclosure: Nothing to disclose.

Burt Cagir, MD, FACS Assistant Professor of Surgery, State University of New York, Upstate Medical Center; 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.

John Geibel, MD, DSc, MA Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of 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 Other

Dawn Hackshaw, MD Consulting Staff, Northwest Pediatrics, Inc

Disclosure: Nothing to disclose.

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

Disclosure: RFA Medical None Director; MRC Biotec None Director

Harold K Simon, MD, MBA Professor of Pediatrics and Emergency Medicine, Associate Division Director of Pediatric Emergency Medicine, Director of Research, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston

Harold K Simon, MD, MBA is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, American Pediatric Society, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose

  1. Golding MR. Protection from early and late sequelae of frostbite by regional sympathectomy: mechanism of "cold sensitivity" following frostbite. Surgery. 1963;53:303-310.:

  2. Hashmi MA, Rashid M, Haleem A, Bokhari SA, Hussain T. Frostbite: epidemiology at high altitude in the Karakoram mountains. Ann R Coll Surg Engl. 1998 Mar. 80(2):91-5. [Medline]. [Full Text].

  3. Cappaert TA, Stone JA, Castellani JW, Krause BA, Smith D, Stephens BA. National Athletic Trainers' Association position statement: environmental cold injuries. J Athl Train. 2008 Oct-Dec. 43(6):640-58. [Medline]. [Full Text].

  4. Terra M, Vloemans AF, Breederveld RS. Frostbite injury: a paragliding accident at 5500 meters. Acta Chir Belg. 2013 Mar-Apr. 113 (2):143-5. [Medline].

  5. Russell KW, Imray CH, McIntosh SE, Anderson R, Galbraith D, Hudson ST, et al. Kite skier's toe: an unusual case of frostbite. Wilderness Environ Med. 2013 Jun. 24 (2):136-40. [Medline].

  6. Connor RR. Update: cold weather injuries, active and reserve components, U.S. Armed Forces, July 2009-June 2014. MSMR. 2014 Oct. 21 (10):14-9. [Medline].

  7. McCauley RL, Hing DN, Robson MC, Heggers JP. Frostbite injuries: a rational approach based on the pathophysiology. J Trauma. 1983 Feb. 23(2):143-7. [Medline].

  8. Heggers JP, Robson MC, Manavalen K, Weingarten MD, Carethers JM, Boertman JA, et al. Experimental and clinical observations on frostbite. Ann Emerg Med. 1987 Sep. 16(9):1056-62. [Medline].

  9. Rivlin M, King M, Kruse R, Ilyas AM. Frostbite in an adolescent football player: a case report. J Athl Train. 2014 Jan-Feb. 49 (1):97-101. [Medline].

  10. Ikawa G, dos Santos PA, Yamaguchi KT, Stroh-Recor C, Ibello R. Frostbite and bone scanning: the use of 99m-labeled phosphates in demarcating the line of viability in frostbite victims. Orthopedics. 1986 Sep. 9(9):1257-61. [Medline].

  11. Koehler MM, Henninger CA. Orofacial and digital frostbite caused by inhalant abuse. Cutis. 2014 May. 93 (5):256-60. [Medline].

  12. Kahn JE, Lidove O, Laredo JD, Blétry O. Frostbite arthritis. Ann Rheum Dis. 2005 Jun. 64(6):966-7. [Medline]. [Full Text].

  13. Uygur F, Sever C, Noyan N. Frostbite burns caused by liquid oxygen. J Burn Care Res. 2009 Mar-Apr. 30(2):358-61. [Medline].

  14. Kanzenbach TL, Dexter WW. Cold injuries. Protecting your patients from the dangers of hypothermia and frostbite. Postgrad Med. 1999 Jan. 105(1):72-8. [Medline].

  15. Koljonen V, Andersson K, Mikkonen K, Vuola J. Frostbite injuries treated in the Helsinki area from 1995 to 2002. J Trauma. 2004 Dec. 57(6):1315-20. [Medline].

  16. McIntosh SE, Opacic M, Freer L, Grissom CK, Auerbach PS, Rodway GW, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update. Wilderness Environ Med. 2014 Dec. 25 (4 Suppl):S43-54. [Medline].

  17. Hutchison RL. Frostbite of the hand. J Hand Surg Am. 2014 Sep. 39 (9):1863-8. [Medline].

  18. Dana AS Jr, Rex IH Jr, Samitz MH. The hunting reaction. Arch Dermatol. 1969 Apr. 99(4):441-50. [Medline].

  19. Hirai K, Horvath SM, Weinstein V. Differences in the vascular hunting reaction between Caucasians and Japanese. Angiology. 1970 Sep. 21(8):502-10. [Medline].

  20. Jobe JB, Goldman RF, Beetham WP Jr. Comparison of the hunting reaction in normals and individuals with Raynaud's disease. Aviat Space Environ Med. 1985 Jun. 56(6):568-71. [Medline].

  21. Tanaka M. Experimental studies on human reaction to cold. Differences in the vascular hunting reaction to cold according to sex, season, and environmental temperature. Bull Tokyo Med Dent Univ. 1971 Dec. 18(4):269-80. [Medline].

  22. Zook N, Hussmann J, Brown R, Russell R, Kucan J, Roth A, et al. Microcirculatory studies of frostbite injury. Ann Plast Surg. 1998 Mar. 40(3):246-53; discussion 254-5. [Medline].

  23. McCauley RL, Heggers JP, Robson MC. Frostbite. Methods to minimize tissue loss. Postgrad Med. 1990 Dec. 88(8):67-8, 73-7. [Medline].

  24. Golant A, Nord RM, Paksima N, Posner MA. Cold exposure injuries to the extremities. J Am Acad Orthop Surg. 2008 Dec. 16(12):704-15. [Medline].

  25. DeGroot DW, Castellani JW, Williams JO, Amoroso PJ. Epidemiology of U.S. Army cold weather injuries, 1980-1999. Aviat Space Environ Med. 2003 May. 74(5):564-70. [Medline].

  26. Valnicek SM, Chasmar LR, Clapson JB. Frostbite in the prairies: a 12-year review. Plast Reconstr Surg. 1993 Sep. 92(4):633-41. [Medline].

  27. Ervasti O, Juopperi K, Kettunen P, Remes J, Rintamäki H, Latvala J, et al. The occurrence of frostbite and its risk factors in young men. Int J Circumpolar Health. 2004 Mar. 63(1):71-80. [Medline].

  28. Juopperi K, Hassi J, Ervasti O, Drebs A, Näyhä S. Incidence of frostbite and ambient temperature in Finland, 1986-1995. A national study based on hospital admissions. Int J Circumpolar Health. 2002 Nov. 61(4):352-62. [Medline].

  29. Koutsavlis AT, Kosatsky T. Environmental-temperature injury in a Canadian metropolis. J Environ Health. 2003 Dec. 66(5):40-5. [Medline].

  30. Harirchi I, Arvin A, Vash JH, Zafarmand V. Frostbite: incidence and predisposing factors in mountaineers. Br J Sports Med. 2005 Dec. 39(12):898-901; discussion 901. [Medline]. [Full Text].

  31. Mäkinen TM, Jokelainen J, Näyhä S, Laatikainen T, Jousilahti P, Hassi J. Occurrence of frostbite in the general population--work-related and individual factors. Scand J Work Environ Health. 2009 Oct. 35(5):384-93. [Medline].

  32. Craig RP. Military cold injury during the war in the Falkland Islands 1982: an evaluation of possible risk factors. J R Army Med Corps. 2007. 153 Suppl 1:63-8; discussion 69. [Medline].

  33. Burgess JE, Macfarlane F. Retrospective analysis of the ethnic origins of male British army soldiers with peripheral cold weather injury. J R Army Med Corps. 2009 Mar. 155(1):11-5. [Medline].

  34. Maley MJ, Eglin CM, House JR, Tipton MJ. The effect of ethnicity on the vascular responses to cold exposure of the extremities. Eur J Appl Physiol. 2014 Nov. 114 (11):2369-79. [Medline].

  35. Brown FE, Spiegel PK, Boyle WE Jr. Digital deformity: an effect of frostbite in children. Pediatrics. 1983 Jun. 71(6):955-9. [Medline].

  36. Long WB 3rd, Edlich RF, Winters KL, Britt LD. Cold injuries. J Long Term Eff Med Implants. 2005. 15(1):67-78. [Medline].

  37. McCauley RL. Frostbite and other cold induced injuries. In: Auerbach PS, ed. Wilderness Medicine. St Louis, MO: Mosby; 1995:129-45:

  38. Roche-Nagle G, Murphy D, Collins A, Sheehan S. Frostbite: management options. Eur J Emerg Med. 2008 Jun. 15(3):173-5. [Medline].

  39. Kowal-Vern A, Latenser BA. Demographics of the homeless in an urban burn unit. J Burn Care Res. 2007 Jan-Feb. 28(1):105-10. [Medline].

  40. Ducharme MB, Giesbrecht GG, Frim J, Kenny GP, Johnston CE, Goheen MS, et al. Forced-air rewarming in -20 degrees C simulated field conditions. Ann N Y Acad Sci. 1997 Mar 15. 813:676-81. [Medline].

  41. Britt LD, Dascombe WH, Rodriguez A. New horizons in management of hypothermia and frostbite injury. Surg Clin North Am. 1991 Apr. 71(2):345-70. [Medline].

  42. Martínez Villén G, García Bescos G, Rodriguez Sosa V, Morandeira García JR. Effects of haemodilution and rewarming with regard to digital amputation in frostbite injury: an experimental study in the rabbit. J Hand Surg Br. 2002 Jun. 27(3):224-8. [Medline].

  43. Ibrahim AE, Goverman J, Sarhane KA, Donofrio J, Walker TG, Fagan SP. The emerging role of tissue plasminogen activator in the management of severe frostbite. J Burn Care Res. 2015 Mar-Apr. 36 (2):e62-6. [Medline].

  44. Twomey JA, Peltier GL, Zera RT. An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite. J Trauma. 2005 Dec. 59(6):1350-4; discussion 1354-5. [Medline].

  45. Handford C, Buxton P, Russell K, Imray CE, McIntosh SE, Freer L. Frostbite: a practical approach to hospital management. Extrem Physiol Med. 2014. 3:7. [Medline].

  46. Bruen KJ, Ballard JR, Morris SE, Cochran A, Edelman LS, Saffle JR. Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy. Arch Surg. 2007 Jun. 142(6):546-51; discussion 551-3. [Medline].

  47. Folio LR, Arkin K, Butler WP. Frostbite in a mountain climber treated with hyperbaric oxygen: case report. Mil Med. 2007 May. 172(5):560-3. [Medline].

  48. Kemper TC, de Jong VM, Anema HA, van den Brink A, van Hulst RA. Frostbite of both first digits of the foot treated with delayed hyperbaric oxygen:a case report and review of literature. Undersea Hyperb Med. 2014 Jan-Feb. 41 (1):65-70. [Medline].

  49. Poulakidas S, Cologne K, Kowal-Vern A. Treatment of frostbite with subatmospheric pressure therapy. J Burn Care Res. 2008 Nov-Dec. 29(6):1012-4. [Medline].

  50. Purkayastha SS, Bhaumik G, Chauhan SK, Banerjee PK, Selvamurthy W. Immediate treatment of frostbite using rapid rewarming in tea decoction followed by combined therapy of pentoxifylline, aspirin & vitamin C. Indian J Med Res. 2002 Jul. 116:29-34. [Medline].

  51. Lau KN, Park D, Dagum AB, Bui DT. Two for one: salvage of bilateral lower extremities with a single free flap. Ann Plast Surg. 2008 May. 60(5):498-501. [Medline].

Frostbite of the foot. Photo courtesy of Kevin P. Kilgore, MD, Department of Emergency Medicine, Regions Hospital.
Frostbite of the ear. Photo courtesy of Kevin P. Kilgore, MD, Department of Emergency Medicine, Regions Hospital.
Frostbite of the hand.
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