What is frostbite?

Updated: Jul 29, 2019
  • Author: Bobak Zonnoor , MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Frostbite, the most common type of freezing injury, is defined as the freezing and crystalizing of fluids in the interstitial and cellular spaces as a consequence of prolonged exposure to freezing temperatures. This article deals with the clinical presentation and treatment of frostbite as a distinct entity. (See also Cold Injuries, Fingertip Injuries, and Frostbite.) Associated conditions, such as hypothermia, pernio (chilblains), and trench foot, are discussed elsewhere and will not be addressed in detail here.

Frostbite may occur when skin is exposed to extreme cold, at times combined with high winds, resulting in vasoconstriction. The associated decrease in blood flow does not deliver sufficient heat to the tissue to prevent the formation of ice crystals. The anatomic sites most susceptible to frostbite include hands, feet, and exposed tissues (eg, ears, nose, and lips).

Because frostbite tends to occur in the same setting as hypothermia, most cases are observed in the winter. Homeless individuals, those who work outdoors, winter sport enthusiasts, and mountaineers are examples of those at risk. [1, 2, 3] More novel activities that can predispose to frostbite include paragliding at extreme heights [4] and kite skiing. [5] The prevalent use of alcohol in colder climates is a factor as well. High-altitude mountaineering frostbite, a variant of frostbite that combines tissue freezing with hypoxia and general body dehydration, has a worse prognosis.

Until the late 1950s, frostbite was a disease entity primarily reported by the world’s military, which had the most experience in its diagnosis and treatment. Most of the data in the current literature originated from military studies or from Scandinavian countries. [6] However, civilian physicians are becoming more cognizant of the diagnosis and treatment of this condition in urban and rural civilian populations. A scientifically based treatment protocol for frostbite was developed by McCauley et al in 1983. [7]

In addition, as with the appearance of high-altitude frostbite in World War II bomber crews, reports of novel causes of frostbite continue to appear in the literature. These include ice pack burns, [8, 9] recreational use of nitrous oxide and other volatile agents, [10, 11] liquid nitrogen handling, [12] liquid oxygen handling, [13] fluorinated hydrocarbon propellant abuse, [14] and work with pressurized liquid ammonia. [15]

The goal of frostbite treatment is to salvage as much tissue as possible, to achieve maximal return of function, and to prevent complications. This may involve both medical and surgical measures as appropriate.


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