Frostbite on Denali: a case series and review of treatment options

Frostbite, defined as tissue freezing due to cold weather exposure, is a major risk associated with mountaineering in cold climates. It represents a significant source of morbidity in the climbing population. In 2021, three individuals were evaluated at a single institution after developing frostbite while climbing Denali, Alaska, US. The affected patients were healthy men in the third to sixth decade of their lives, and all experienced frostbite injuries involving the fingers. Among the patients, one individual was unable to descend from the mountain due to the severity of his condition and required medical evacuation. The other men were able to descend without significant difficulty. After leaving the mountain, the patients were treated with thrombolysis, pentoxifylline, hyperbaric oxygen therapy, and/or regional sympathetic blockade. Exposure to cold weather, ascent to high altitudes, and increased mechanisms of heat loss were likely potential risk factors for frostbite injury in these patients. Psychological factors related to the COVID-19 pandemic may have also impacted these individuals' risk for frostbite injury. Prevention is the most effective way to avoid frostbite, and knowledge and understanding of the risks associated with the development of this condition may reduce future occurrences among mountaineers. Since frostbite is not a common diagnosis encountered in patients treated in outpatient wound centres, physicians should maintain awareness of the pathophysiology and treatment options for this condition.