Early treatment of frostbite with hyperbaric oxygen and pentoxifylline: a case report

While several published cases have reported tissue preservation with hyperbaric oxygen (HBO2) after frostbite, its routine use is not endorsed by expert consensus. We report a case of possible frostbite injury to the toes of both feet and the plantar surface of the left foot in a 17-year-old male patient. The exposure history included two episodes of rewarming followed by refreezing in the field during a hike through knee-deep snow without adequate clothing. The patient also sustained full-thickness ice abrasions to both anterior shins. The patient was evaluated within 60 minutes after self-rewarming. He was treated with 400 mg oral pentoxifylline three times a day and HBO2 at 2.4 atmospheres absolute for 90 minutes twice a day for a total of 13 treatments. Therapy was initiated approximately two hours from the estimated time of rewarming. Both feet recovered full sensation, and the patient had no tissue loss on his feet and and no functional impairment. The patient was followed for 12 months from injury. This case report highlights the difficulty health care providers face to accurately diagnose frostbite within the first 24 hours of injury, prior to development of more definitive signs and symptoms. Early treatment during this critical period may preserve tissue and function.