Frostbite can lead to severe consequences to a patient, including loss of digits and limbs. It causes tissue injury by causing cell membrane damage through the formation of extracellular ice crystals and by causing vascular thrombosis. It is to reverse the latter process that the use of tissue Plasminogen Activator (tPA) has been introduced. In this retrospective study, the authors share their experience on using tPA for patients with severe frostbite. A total of 38 patients were treated for frostbite, however, only seven patients met the criteria for tPA treatment. These patients had rewarming <24 hrs before initiation of treatment protocol, had no digital pulses on doppler scan and Tc-99m scans showed poor distal limb perfusion. After administration of tPA, patients were started on anticoagulant / antiplatelet therapy. Five patients recovered fully post tPA. Two patients had bleeding while on heparin and had their anticoagulation stopped. These two patients went on to have necrosis of the digits and amputation. The evidence for the use of tPA in frostbite has only been shown to be effective in case reports and small prospective studies. This could be due to the rarity of cases of severe frostbite injuries. Although this is a small retrospective case series, it adds to the limited amount of evidence currently available for the use of tPA in frostbite injuries.

The use of intravenous tPA for the treatment of severe frostbite.
Jones LM, Coffey RA, Natwa MP, Bailey JK.
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Kuen Y Chin

ST6 Plastic Surgery, St John’s Hospital, Livingston, UK

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