Using thrombolytics in frostbite injury

Abstract

Until recently, the treatment of frostbite injuries has been limited to supportive care only, with mediocre outcomes. The use of thrombolytic therapy has been presented in a limited fashion in the literature since 2005. This case study describes the work-up and treatment of a patient with severe frostbite injury who received tPA. We then discuss thrombolytic therapy in more detail, with particular attention to the two studies outlining different treatment regimens.

Keywords: Frostbite; cold injury; hypothermia; thrombolytic.

Figure 1

Left hand after rewarming

Figure 2

Right hand after rewarming

Figure 3

Initial bone scan prior to thrombolytic therapy. There is no perfusion identified within the left 3^rd through 5^th digits and right 4^th and 5^th digits, and a small amount of uptake at the base of the right first 3 digits and left 1^st and 2^nd digits

Figure 4

(a-b): Bone scan after thrombolytic therapy showing increased perfusion in the first through 4^th digits bilaterally to at least the proximal interphalangeal joints, and in the 5^th digits bilaterally, more modestly improved flow to the mid proximal phalanx level