Frostbite to the upper limb: An updated review and management recommendations

Frostbite belongs to a broad spectrum of clinical conditions related to cold exposure. The increasing popularity of winter sports and high-altitude activities, combined with the inexperience of some participants, has led to a rising incidence and severity of frostbite cases. In recent years, new therapeutic approaches have emerged that improve patient management. This article reviews the main recommendations for the diagnostic, therapeutic, and preventive management of frostbite, and explores innovative treatment strategies.

A literature review was conducted on PubMed and Google Scholar using the keywords "frostbite" AND "management" for articles published between 2017 and 2023.

A total of 80 articles were found on PubMed and 869 on Google Scholar. After merging duplicates and applying the exclusion criteria, a total of 56 articles were included in the analysis.

Significant advancements have been made in the management of frostbite over the last few decades, accompanied by a better understanding of the pathophysiological mechanisms. Current management strategies include early and rapid rewarming, avoiding re-freezing of warmed tissues, wound dressings and protection, and administering NSAIDs. Thrombolysis with rt-PA and intravenous Iloprost administration have resulted in improved outcomes for patients suffering with frostbite. Among the various diagnostic methods employed, arteriography facilitates the monitoring of thrombolysis treatment, while scintigraphy with technetium-99m allows early prognostication. Newer diagnostic techniques, such as indocyanine green and MRI, hold promise for enhancing management strategies. The potential role of hyperbaric oxygen therapy remains a subject of ongoing research.

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