cancers, and bone destruction / arthritis in the area affected [26]. Tissue that has recovered from frostbite is more susceptible to further injury and this needs to be kept in mind when advising individuals about a return to environments where they may be at risk.

Research

Evidence is insufficient to determine whether or not hyperbaric oxygen therapy as an adjunctive treatment can assist in tissue salvage [26].There have been case reports but few actual research studies to show the effectiveness [27–31]. Medical sympathectomy using intravenous reserpine has also been attempted with limited success [26].

References

[1]Marx J (2010) Rosen’s emergency medicine: concepts and clinical practice, 7th edn. Mosby/Elsevier, Philadelphia, PA, p 1862, ISBN 9 780 323 054 720

[2]Frostbite, eMedicineHealth.com, http://www.emedici nehealth.com/frostbite/article_em.htm, retrieved 4/3/ 10

[3]Definition of Frostbite, MedicineNet.com, http://www. medterms.com/script/main/art. asp? articlekey=3522, retrieved 4/3/10

[4]Perez E (2006) MD. National Institute of Health. Retrieved May 18, 2006

[5]Bhatnagar A, Sarker BB, Sawroop K et al (2002) Diagnosis, characterisation and evaluation of treatment response of frostbite using pertechnetate scintigraphy: a prospective study. Eur J Nucl Med 29: 170–175

[6]Barker JR, Haws MJ, Brown RE et al (1997) Magnetic resonance imaging of severe frostbite injuries. Ann Plast Surg 38: 275–279

[7]Greenwald D, Cooper B, Gottlieb L (1998) An algorithm for early aggressive treatment of frostbite with limb salvage directed by triple-phase scanning. Plast Reconstr Surg 102: 1069–1074

[8]Mistovich J, Haffen B, Karren K (2004) Prehospital emergency care. Pearson Education, Upsaddle River, NJ, pp 506, ISBN 0–13–049 288–4

[9]Mistovich J, Haffen B, Karren K (2004) Prehospital emergency care. Pearson Education, Upsaddle River, NJ, p 504, ISBN 0–13–049 288–4

[10]Roche-Nagle G, Murphy D, Collins A, Sheehan S (2008) Frostbite: management options. Eur J Emerg Med 15 (3): 173–175, doi:10 1097/MEJ.0b013e3282bf6ed0] PMID 184 609Retrieved 2008–06–30

[11]Marx J (2010) Rosen’s emergency medicine: concepts and clinical practice 7th edition. Mosby/Elsevier, Philadelphia, PA, p 1864, ISBN 9 780 323 054 720

[12]Golant A, Nord RM, Paksima N, Posner MA (2008) Cold exposure injuries to the extremities. J Am Acad Orthop Surg 16 (12): 704–715, PMID 19 056 919

[13]McGillion R (2005) Frostbite: case report, practical summaryofEDtreatment.JEmergNurs31(5): 500–502, doi:10 1016/j. jen.2005.07.0[02] PMID 16 198 741

[14]Salimi Z (1985) Frostbite: assessment of tissue viability by scintigraphy. Postgrad Med 77: 133–134

[15]Mehta RC, Wilson MA (1989) Frostbite injury: prediction of tissue viability with triple-phase bone scanning. Radiology 170: 511–514

[16]Salimi Z, Wolverson MK, Herbold DR, Vas W (1986) Frostbite: experimental assessment of tissue damage using Tc-99 m pyrophosphate. Radiology 161: 227–231

[17]Barker JR, Haws MJ, Brown RE, Kucan JO, Moore WD (1997) Magnetic resonance imaging of severe frostbite. Ann Plast Surg 38: 275–279

[18]Golant A, Nord RM, Paksima N, Posner MA (2008) Cold exposure injuries to the extremities. J Am Acad Orthop Surg 16 (12): 704–715

[19]Taylor MS(1999) Lumbar epidural sympathectomy for frostbite injuries of the feet. Mil Med 164: 566–567

[20]Cauchy E, Cheguillaume B, Chetaille E (2011) A controlled trial of a prostacyclin and rt-PA in the treatment of severe frostbite. N Engl J Med 364(2): 189–190. PMID: 21226604

[21]Hödl S (2005) Treatment of freezing injury. Wien Med Wochenschr 155 (7–8): 199–203

[22]Cauchy E, Chetaille E, Marchand V et al (2001) Retrospective study of 70 cases of severe frostbite lesions: a proposed new classification scheme. Wild Envir Med 12: 248–255

[23]Bruen KJ, Ballard JR, Morris SE et al (2007) Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy. Arch Surg 142: 546–551

[24]Britt LD, Dascombe WH, Rodriguez A (1991) New horizons in management of hypothermia and frostbite injury. Surg Clin North Am 71: 345–370

[25]McCauley RL, Hing DN, Robson MC, Heggers JP (1983) Frostbite injuries: a rational approach based on the pathophysiology. J Trauma 23: 143–147

[26]Marx J (2010) Rosen’s emergency medicine: concepts and clinical practice 7th edition. Mosby/Elsevier, Philadelphia, PA, p 1866, ISBN 9 780 323 054 720

[27]Finderle Z, Cankar K (2002) Delayed treatment of frostbite injury with hyperbaric oxygen therapy: a case report. Aviat Space Environ Med 73 (4): 392–394, PMID 11 952 063

[28]Folio LR, Arkin K, Butler WP (2007) Frostbite in a mountain climber treated with hyperbaric oxygen: case report. Mil Med 172 (5): 560–563, PMID 17 521 112

[29]Gage AA, Ishikawa H, Winter PM (1970)Experimental frostbite. The effect of hyperbaric oxygenation on tissue survival. Cryobiology 7 (1): 1–8] doi:10 1016/0011–2240 (70)90 038–6, PMID 54 750[96] Retrieved 2008–06–30

[30]Weaver LK, Greenway L, Elliot CG (1988) Controlled frostbite injury to mice: outcome of hyperbaric oxygen therapy. J Hyperbaric Med 3 (1): 35–44, Retrieved 2008–06–30

[31]Ay H, Uzun G, Yildiz S, Solmazgul E, Dundar K, Qyrdedi T, Yildirim I, Gumus T (2005) The treatment of deep frostbite of both feet in two patients with hyperbaric oxygen. (abstract). Undersea Hyperb Med 32 (1 [Suppl]), ISSN 1066–29[36] OCLC 269 155[85] Retrieved 2008–06–30

Correspondence: Kraincuk Paul, Ass.-Prof. Dr. med. univ., Universitätsklinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Währinger Gürtel 18–20, 1090 Wien, Austria, E-mail: paul.kraincuk@meduniwien.ac.at