Frostbite injury: an unknown risk when using nitrous oxide as a party drug

In recent years nitrous oxide has become a popular party drug. Large cylinders filled with nitrous oxide are used to fill balloons for recreational use. We present two patients with severe third-degree cold burns on their thighs after clamping a large cylinder between their legs while filling balloons. During filling, large amounts of nitrous oxide are inhaled, which causes the pain to be numbed. As nitrous oxide is discharged from the cylinder, the cylinder becomes ice cold. Due to direct contact with the icecold cylinder and numbness, third-degree frostbite wounds occur. In both cases presented, the burn wounds had to be debrided and treated with split-thickness skin transplants. Awareness is needed as at first presentation as the burns look superficial, but can rapidly develop into third-degree burn wounds. Close follow-up and aggressive treatment is necessary to prevent infections and to regain a good functional outcome of the affected limb.