摘要
Background:Frostbite is a cold injury that has the potential to cause considerable morbidity and long-term disability.Despite the complexity of these patients,diagnostic and treatment practices lack standardization.Thrombolytic therapy has emerged as a promising treatment modality,demonstrating impressive digit salvage rates.We review our experience with thrombolytic therapy for severe upper extremity frostbite.Methods:Retrospective data on all frostbite patients evaluated at our institution from December 2017 to March 2018 was collected.A subgroup of patients with severe frostbite treated with intraarterial thrombolytic therapy(IATT)were analysed.Results:Of the 17 frostbite patients treated at our institution,14(82%)were male and the median age was 31(range:19–73).Substance misuse was involved in a majority of the cases(58.8%).Five(29.4%)patients with severe frostbite met inclusion criteria for IATT and the remaining patients were treated conservatively.Angiography demonstrated a 74.5%improvement in perfusion after tissue plasminogen activator thrombolysis.When comparing phalanges at risk on initial angiography to phalanges undergoing amputation,the phalangeal salvage rate was 83.3%and the digit salvage rate was 80%.Complications associated with IATT included groin hematoma,pseudoaneurysm and retroperitoneal hematoma.Conclusions:Thrombolytic therapy has the potential to greatly improve limb salvage and functional recovery after severe frostbite when treated at an institution that can offer comprehensive,protocoled thrombolytic therapy.A multi-center prospective study is warranted to elucidate the optimal treatment strategy in severe frostbite.
