Treatment of frostbite with subatmospheric pressure therapy

Frostbite may result in loss of skin and tissue requiring amputation; it occurs most often on the exposed areas such as extremity digits, ears, etc. The usual treatment is observation for demarcation of the injury before amputation or autoamputation of the dry gangrene that may set in between 1 and 3 weeks. In some instances, tissue viability is assessed by a pyrophosphate nuclear scan. This was a 43-year-old African-American man who developed frostbite of his right foot. He presented 72 hours after injury with hyperemia and cellulitis over the dorsum of the foot and a blistered dorsal surface of the great toe with loss of sensation on all toes and early signs of necrosis. The patient received a 7-day course of ampicillin-sulbactam and a 6-day course of vacuum-assisted closure therapy during a 7-day hospitalization. At the time of discharge, he had re-epithialialization of the dorsal surface of the right toe and healthy granulation tissue with islands of epidermis emerging on the ventral surface of the right toe. Re-epithelialization was complete by 26 days after injury. In the future, this treatment therapy may find a larger application in frostbite injuries because it may accelerate healing. A study of frostbite treatment confirming the usefulness of this modality may be indicated.