[Treatment of freezing cold injuries]

The keys to successful treatment of freezing cold injuries are proper recognition and grading of the injury, followed by appropriate treatment within the first 24 hours. In the latter stages, challenges remain but are less time sensitive. The thawing process, in a water bath with a temperature of 37-39°C, is painful and requires ambitious pain relief. Thawing initiates an inflammation cascade at the cellular level resulting in micro embolies disrupting the micro-circulation. This mechanism explains why more severe frostbite injuries can be successfully treated with thrombolytic therapy and drugs such as iloprost and NSAID. These treatments must, for the same reason, be initiated within the first days after thawing. Imaging methods such as angiography, CT or bone scintigraphy give valuable added information to complement clinical examination after thawing. Proper wound care is of essence and aggressive surgery, such as amputation, should be postponed until definite clinical demarcation of necrosis is established.