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The aim of the study was to investigate the effects of the rhGM-CSF gel on third-degree frostbite wounds. Sixty-two patients who had suffered third-degree frostbite on their hand or foot (91 wounds in total) were selected using a convenience sampling method and randomly allocated to two groups: the rhGM-CSF group(31patients,45 frostbite wounds) received the rhGM-CSF gel when wound dressing change daily; however, the control group (31patients, 46 frostbite wounds) received aloe glue. The wound healing time, the score of inflammation about the wound and the positive bacterial culture of wound secretions were used to measure outcomes, respectively. Data were analyzed using SPSS (25.0), Student's t test or Mann–Whitney U test and chi-square test or Fisher exact test were selected, as appropriate. The healing time of the rhGM-CSF group was (12.2 ± 5.0) days, which was significantly shorter than that of the control group (15.5 ± 4.7) days (P <.0001). The rhGM-CSF group's wound inflammation scores on the 7th and 14th day of treatment were (0.96 ± 0.21) and (1.88 ± 0.29), respectively, which were better than those of the control group (1.12 ± 0.24) and (1.38 ± 0.15) (both P <.0001). The positive bacterial culture of wound secretions in the rhGM-CSF group was also better than that in the control group on the 3rd, 7th, and 14th day after treatment (P =.027,.004,.030, respectively). According to the results, using rhGM-CSF gel considerably increases the speed of frostbite wounds healing, and have an effect on protecting third-degree frostbite wounds regarding the positive effects. Trial Registration: This trial was registered in the Chinese Clinical Trial Register, ChiCTR1900021299. [ABSTRACT FROM AUTHOR]

The study aimed to develop and validate a convolutional neural network (CNN)‐based deep learning method for automatic diagnosis and graduation of skin frostbite. A dataset of 71 annotated images was used for the training, the validation, and the testing based on ResNet‐50 model. The performances were evaluated with the test set. The diagnosis and graduation performance of our approach was compared with two residents from burns department. The approach correctly identified all the frostbite of IV (18/18, 100%), but with respectively 1 mistake in the diagnosis of degree I (29/30, 96.67%), II (28/29, 96.55%) and III (37/38, 97.37%). The accuracy of the approach on the whole test set was 97.39% (112/115). The accuracy of the two residents were respectively 77.39% and 73.04%. Weighted Kappa of 0.583 indicates good reliability between the two residents (P =.445). Kendall's coefficient of concordance is 0.326 (P =.548), indicating differences in accuracy between the approach and the two residents. Our approach based on CNNs demonstrated an encouraging performance for the automatic diagnosis and graduation of skin frostbite, with higher accuracy and efficiency. [ABSTRACT FROM AUTHOR]

Frostbite is a traumatic injury of the tissues upon low temperature environment exposure, which is characterized by direct cell injury due to freezing-thawing followed by development of an acute inflammatory process. Severe frostbite can lead to necrosis of soft tissues and loss of a limb. Mesenchymal stromal cells (MSCs) have a unique ability to modulate pathogenic immune response by secretion of paracrine factors, which suppress inflammation and mediate more efficient tissue regeneration. It should be noted that potential of stem cell therapy for frostbite injury treatment has not been investigated so far. Here, we evaluated a healing capacity of bone-marrow derived MSCs for the treatment of contact frostbite injury wound in a rat model. Cold-contact injury in a Wistar rat model was induced by 1-minute tight application of the cooled probe (−196 ⁰C) to the skin surface of the left hip. Rat bone marrow MSCs were phenotypically characterized and used for local injections into non-damaged tissues surrounding the wound of animals from the experimental group. The second group of rats was treated in the same manner with 1 mL of isotonic sodium chloride solution. Analysis of cytokine and growth factor expression profile in сold-contact injury wounds was performed on days 5, 9, and 16 using immunoblotting and enzyme-linked immunosorbent assay. Animal recovery in MSC-treated and vehicle-treated groups was evaluated by several criteria including body weight recording, determination of eschar desquamation and re-epithelialization terms, assessment of wound closure kinetics, and histological scoring of the wounds on day 23. It turned out that a single subcutaneous administration of MSCs around the wound site resulted in elevated expression of pro-survival and pro-angiogenic VEGF-A and PDGF and 3–5-fold decrease in pro-inflammatory IL-1β as compared with the frostbite wound treated with a vehicle. Moreover, treatment with MSCs caused accelerated wound re-epithelialization (p < 0.05) as well as a better histological score of the MSC-treated wounds. Thus, our data suggested that the use of MSCs is a promising therapeutic strategy for the treatment of cold-induced injury wounds. • Wound healing capacity of bone-marrow derived mesenchymal stromal cells (MSCs) for the treatment of frostbite injury. • Local injection of MSCs alters cytokine and growth factor expression in a contact frostbite injury wound. • Treatment with MSCs accelerates re-epithelialization and improves histological score of a cold-contact injury wound. [ABSTRACT FROM AUTHOR]

The systemic and respiratory clinical manifestations of coronavirus disease 2019 (COVID‐19) include fever, coughing, sneezing, sore throat, rhinitis, dyspnea, chest pain, malaise, fatigue, anorexia and headache. Moreover, cutaneous manifestations have been reported in 0.2% to 20.4% of cases. Early diagnosis of COVID‐19 leads to a better prognosis; knowledge of its cutaneous manifestations is one way that may help fulfil this goal. In this review, PubMed and Medline were searched with the terms "dermatology", "skin" and "cutaneous", each in combination with "SARS‐CoV‐2" or "COVID‐19". All articles, including original articles, case reports, case series and review articles published from the emergence of the disease to the time of submission, were included. In this comprehensive narrative review, we tried to provide an analysis of the cutaneous manifestations associated with COVID‐19, including maculopapular rash, urticaria, Chilblain‐like, vesicular lesions, livedo reticularis and petechiae in asymptomatic/symptomatic COVID‐19 patients that might be the first complication of infection after respiratory symptoms. Immune dysregulation, cytokine storms, side effects of antiviral drugs, environmental conditions and high‐dose intravenous immunoglobulin (IVIG) therapy might be involved in the pathogenesis of the cutaneous manifestations in COVID‐19 patients. Therefore, knowledge of cutaneous COVID‐19 manifestations might be vital in achieving a quick diagnosis in some COVID‐19 patients, which would help control the pandemic. Further research is very much warranted to clarify this issue. [ABSTRACT FROM AUTHOR]

Introduction and purpose Frostbite is a serious injury caused by cold, which is an inseparable element of human contact with nature. It can cause tissue damage and loss of function if not properly treated. It treatment consists of several stages that require the involvement of many people. The purpose of the article is to summarize information on epidemiology, pathophysiology, prehospital and hospital procedures and to draw attention to the complexity of patient care. Materials and methods A literature review based on PubMed and Google Scholar using the following keywords: frostbite, cold injury. Description of the state of knowledge: The literature review shows the breadth of the issue. The effectiveness of therapy depends on: knowledge of pathophysiology and risk factors, early diagnosis, discontinuation of exposure to cold, effective analgesic treatment, fluid therapy, transport of the victim to the appropriate center, rapid warming of frozen tissues, imaging diagnostics, initiation of thrombolytic treatment and, if necessary, surgery. It is also important to remember about long-term complications that worsen the quality of life of patients, such as chronic pain, hyperaesthesia or impairment or loss of limb functionality. Conclusions Frostbite is a relatively rare problem, but especially in winter, every medic will have to deal with it sooner or later. Considering the above information, the management of a patient with frostbite is a demanding and long-term process in which the cooperation and involvement of many medics is important, so it is worth having knowledge about them.

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal disease that may be treated utilizing thermal therapies. Cryoablation is an effective, minimally invasive therapy that has been utilized for the treatment of various cancers, offering patients a quicker recovery and reduced side effects. Cryoablation has been utilized on a limited basis for the treatment of PDAC. With the recent reports on the success of cryoablation, there is a growing interest in the use of cryoablation as a standalone, minimally invasive procedure to treat PDAC. While offering a promising path, the application of cryoablation to PDAC is limited by current technologies. As such, there is a need for the development of new devices to support advanced treatment strategies for PDAC. To this end, this study investigated the performance of a new endoscopic ultrasound-compatible cryoablation catheter technology, FrostBite. We hypothesized that FrostBite would enable the rapid, effective, minimally invasive delivery of ultra-cold temperatures to target tissues, resulting in effective ablation via an endoscopic approach. Thermal properties and ablative efficacy were evaluated using a heat-loaded gel model, tissue-engineered models (TEMs), and an initial in vivo porcine study. Freeze protocols evaluated included single and repeat 3 and 5 min applications. Isotherm assessment revealed the generation of a 2.2 cm diameter frozen mass with the −20 °C isotherm reaching a diameter of 1.5 cm following a single 5 min freeze. TEM studies revealed the achievement of temperatures ≤ −20 °C at a diameter of 1.9 cm after a 5 min freeze. Fluorescent imaging conducted 24 h post-thaw demonstrated a uniformly shaped ellipsoidal ablative zone with a midline diameter of 2.5 cm, resulting in a total ablative volume of 6.9 cm3 after a single 5 min freeze. In vivo findings consistently demonstrated the generation of ablative areas measuring 2.03 cm × 3.2 cm. These studies demonstrate the potential of the FrostBite cryocatheter as an endoscopic ultrasound-based treatment option. The data suggest that FrostBite may provide for the rapid, effective, controllable freezing of cancerous pancreatic and liver tissues. This ablative power also offers the potential of improved safety margins via the minimally invasive nature of an endoscopic ultrasound-based approach or natural orifice transluminal endoscopic surgery (NOTES)-based approach. The results of this pre-clinical feasibility study show promise, affirming the need for further investigation into the potential of the FrostBite cryocatheter as an advanced, minimally invasive cryoablative technology.

Key Clinical Message: Frostbite arising from nitrous oxide (N2O) inhalation is rare. As such, there is no consensus on best treatment for these injuries. In all published reports, judicious use of corticosteroids and antibiotics has resulted in positive clinical outcomes; we endorse these agents in our case of a young man with oropharyngeal burns. [ABSTRACT FROM AUTHOR]

• Frostbite injury differs from other burn types with its more complex injury mechanism. • The effects of stromal vascular fraction in an experimental frostbite injury model. • Increased tissue perfusion was observed on wounds injected with stromal vascular fraction. • Stromal vascular fraction has beneficial effects on frostbite injury model. Despite current treatment modalities, frostbite remains an injury with a poor prognosis which may cause functional morbidities. Several experimental and clinical studies have demonstrated that stromal vascular fraction is an autologous mixture, which can improve wound healing and vasculogenesis. The aim of this study was to show the beneficial effects of stromal vascular fraction on experimental frostbite healing. Stromal vascular fraction (SVF) was harvested from 5 rats after excision of the inguinal fat pads. Another 20 rats were separated into 2 groups of 10 as the SVF group and the control group. A frostbite injury was created on each rat using a cryoprobe frozen with liquid nitrogen (−196 °C). SVF was applied to the SVF group and phosphate-buffered saline to the control group. All injections were performed subcutaneously within the frostbite injury area. Biopsies were performed on days 5 and 14 for histopathological and immunochemical evaluations. The tissue perfusion rates of both groups were assessed on day 14 using indocyanine green angiography (SPY system). The increase in mean tissue perfusion was 373.3% (± 32.1) in the SVF group and 123.8% (± 16.3) in the control group (p < 0.001). The macroscopic wound reduction rates of the SVF and control groups were 25.5% (± 19.1) and 18.0% (± 5.9), respectively on day 5%, and 78.2% (± 9.2) and 57.3% (± 16.7) on day 14 (p = 0.007; p = 0.003). Acute inflammation and the fibrosis gradient were significantly decreased in the SVF group compared to the control group (p = 0.004, p = 0.054 respectively on day 14). Granulation tissue amount, re-epithelialization score and neovascularization were significantly increased in the SVF group (p = 0.006, p = 0.010 and p = 0.021, respectively on day 14). The study results demonstrated that SVF increases frostbite wound healing by increasing tissue perfusion rate, neovascularization and re-epithelialization, and modulating acute inflammation and fibrosis. [ABSTRACT FROM AUTHOR]

Hypothermia is a medical condition in which the body’s core temperature is abnormally low and may interfere with physiologic processes. It may be accidental or secondary to other medical conditions. The body has many methods in place to maintain core temperature within a strict range for optimal function. When these processes are disrupted, complications including dysrhythmias, neurologic decline, cardiac arrest and frostbite may occur. The presentation and management of these conditions will be discussed. [ABSTRACT FROM AUTHOR]

Drug treatment of limb frostbite injuries is complicated due to the poor delivery of medications to affected tissues. External rewarming of the frostbitten area is risky and does not always result in positive outcomes because the dilatation of superficial vessels with constricted deep vessels can lead to irreversible damage, necrosis, and amputation. One of the techniques to restore perfusion of deep vessels in an affected extremity is rewarming with low-power microwave radiation in a specially designed metal chamber. Below are findings following treatment of 14 volunteers with this technique in 2 Tomsk hospitals during winters of 2018–2021. It is demonstrated that timely, i.e. in the early reactive period, application of microwave radiation and appropriate supportive drug treatment results in positive amputation-free outcomes. The key requirement is prompt thermal insulation of the trauma and no prior exposure to external heat sources. [ABSTRACT FROM AUTHOR]

There are nine year-round and 11 seasonal scientific stations in the South Shetland Islands, an area often visited by cruise ships and sailing yachts. Although this is the warmest part of Antarctica, the weather conditions may be demanding for humans. We analysed the variability of biothermal conditions near Henryk Arctowski Station Polish Antarctic Station, on King George Island, during the period 2013–2021, using the wind chill index (WCI), which combines air temperature and wind speed, to determine thermal sensation. WCI values were interpreted using two cold sensation categorisations. Hourly WCI values were assigned to thermal sensation classes that ranged from “comfortable” to “frosty.” The most favourable biothermal conditions occurred from December to February. The “cold” sensation was dominant in all months, its average occurrence frequency ranging from 56.4% (in January) to 84.4% (in July). From November to March, there was no risk of frostbite to uncovered body parts. Such conditions occurred only from April to October, with a frequency of 0.2–6.8%; biothermal conditions were also the most variable in this period. Maximal WCI hourly values show that dangerous weather conditions may occur throughout the day in June and for most of the day from July to September. An abrupt change in biothermal conditions was more often caused by wind speed change than by air temperature change. The most marked WCI changes occurred from April to September, on average five times per year. Our results indicate that biothermal conditions in the vicinity of Arctowski Station are predominantly favourable for outdoor work only if a person wears proper winter clothing. [ABSTRACT FROM AUTHOR]

Chilblains were first described over a hundred years ago as cutaneous inflammatory lesions, typically on the digits, occurring on cold exposure. Chilblains can be primary, or secondary to a number of conditions such as infections, including COVID-19, and immune-mediated inflammatory disorders (IMIDs) with SLE being the commonest. Chilblain lupus erythematosus (CHLE) was first described in 1888 as cold-induced erythematous lesions before the terms 'chilblains' or 'perniosis' were coined. Diagnostic criteria exist for both chilblains and CHLE. Histopathologically, CHLE lesions show interface dermatitis with perivascular lymphocytic infiltrate. Immunofluorescence demonstrates linear deposits of immunoglobulins and complement in the dermo-epidermal junction. This narrative review focuses on chilblains secondary to immune-mediated inflammatory disorders, primarily the epidemiology, pathogenesis and treatment of CHLE. [ABSTRACT FROM AUTHOR]

The Khudosey River is the only tributary of the middle reach of the Taz River (Western Siberia) suitable for breeding and wintering whitefish in the conditions of natural suffocation, which continues annually from November to April. The reproduction of whitefish in the Khudosey River was investigated for the first time. They were carried out in 2002, 2003, and 2017–2022. The main spawning grounds of whitefish are described. It has been established that the downstream migration of larvae on the lower border of spawning grounds begins with the first rise of water and ends immediately before the floating of ice. A special natural factor was noted – frostbite from freezing of riffles in spawning grounds, causing the complete death of incubated eggs. There is a high potential for the Khudosey River in the reproduction of whitefish, comparable to the potential of the Ural spawning tributaries of the lower Ob. It was revealed that the increase in the level of reproduction of whitefish of the Taz River can occur due to the migration of fish from the Ob River. [ABSTRACT FROM AUTHOR]

In this study, a strategy of anti-freezing organic hydrogel system is proposed, which can be used as a medical gel dressing for the prevention and treatment of frostbite in extra cold regions. The supramolecular polymer organic hydrogel is a double network gel dressing. β-Cyclodextrin and azobenzene groups form the first supramolecular network through supramolecular host-guest interaction, and acrylamide copolymerization with crosslinker forms the second layer of covalent network. Compared with acrylamide hydrogels, the stress required to reach the same strain at –25°C is 12 times higher than that at 25°C, while the stress required by organic hydrogels at the same conditions slightly changes, indicating that organic hydrogels also show good flexibility at low temperatures. At the same time, double-network organic hydrogel could recover to 70% of original tensile capacity after self-healing. [ABSTRACT FROM AUTHOR]

A common effort for both military and civil healthcare is to achieve knowledge-based health care in cold weather injuries and fatal accidents in harsh arctic environment. The Cold Weather Operations Conference in November 2021, having more than 300 participants from 20 countries, was addressing the prevention and treatment of injuries and trauma care in cold weather conditions and the challenges for military prehospital casualty care. The intention of the programme was to stimulate further research and systematic knowledge-based clinical work. The abstracts from the conference present cold weather research and clinical experience relevant for readers of the International Journal of Circumpolar Health. [ABSTRACT FROM AUTHOR]

The current article aims to analyse the effectiveness of the conversion of the Siachen Glacier into a peace park on India–Pakistan relations. It further investigates how the peace park can build mutual understanding leading to cooperation and peace between the two countries. The article presents the conceptual framework for adequate supervision of the Siachen Glacier jointly by India and Pakistan to mitigate the existing tensions and conflicts through tourism within the context of the tourism–peace nexus and peace park concept. The Siachen Peace Park proposition offers an amazing way out for the policymakers to diffuse tensions between the military establishments of India and Pakistan. Both the nations have been losing the lives of their soldiers among the snow-capped peaks not due to any gunfight but mainly because of climatic extremities and frostbite. The suggestion of the Siachen Peace Park has been explicated with the help of a four-stage peace park conversion model conceived by the authors, which gives a conceptual understanding of the outcomes of this Peace Park for both countries. [ABSTRACT FROM AUTHOR]

In the Crimean War (1854–56), infamous for its high death rate from disease at 212 per thousand British troops annually – one third of which was due to cholera or dysentery – skin disease was common, accounting for 13% of all admissions and 4.2% of all deaths. Excluding typhus, skin disease caused 252 per thousand annual admissions and 8.8 per thousand annual deaths, with an overall case fatality of 3.4%. The commonest skin diseases were: localised cellulitis/abscess, ulcer, venereal disease, frostbite, scurvy, eruptive rashes and scabies. The biggest number of skin disease-related deaths were from frostbite and scurvy. Cutaneous afflictions with the highest case fatality were erysipelas (27%), gangrene (25%), smallpox (21%) and frostbite (19%). Problems from frostbite lessened during the better provisioned second winter. The experience of skin disease in the Crimea highlights the importance of public health and personal sanitation to skin health in the military context, and shows that skin-related infections and nutritional deficiencies easily develop if environmental conditions deteriorate. [ABSTRACT FROM AUTHOR]

Coeliac disease (CD) is a gluten-triggered, immune-mediated inflammatory disease occurring in genetically predisposed individuals, causing a variety of gastrointestinal and extraintestinal symptoms. The most common cutaneous association of CD is dermatitis herpetiformis, although recent reports have sought to link CD with other dermatological and autoimmune diseases. Chilblain, also called pernio, is usually a benign, superficial and localized inflammatory skin disorder that results from a maladaptive vascular response to non-freezing cold. We present a patient with pernio (chilblains) and newly diagnosed CD, with a significant intestinal lesion–total villous atrophy, as there are only two known cases of this feature associated with CD published in the literature. In the workup of chilblains (pernio) in children, an active case finding for coeliac disease should be conducted with coeliac-specific serology testing. [ABSTRACT FROM AUTHOR]

The objective was to explore possibilities with reconstruction of opposable digital stump of the hand transplanted with microvascular anastomoses in frostbite patients. Material and methods Medical histories and long-term results of treatment of two frostbite patients with finger stumps of both hands were reviewed. The triphalangeal finger and the thumb were reconstructed by transplanting the opposable finger stump together with the metacarpophalangeal joint using microvascular and microneural anastomoses. The stumps were mobilized and transplanted to the distal ulnar artery with the venous drainage performed using the dorsal saphenous vein of the hand. Long-term results were examined at 10 years and 2.5 years of surgery. Clinical, radiological, biomechanical and biophysical investigations were produced. Results The bilateral gripping function was restored in recipient stumps without functional damage to the donor stumps. Discriminatory sensitivity of reconstructed fingers was 6mm and 8 mm, the range of active motion in the transplanted joint was 55 and 66 degrees. Discussion Opposable digital stump transplantation with microvascular anastomoses has significant advantages over the classical surgery. The technique allows for one-stage restoration of a finger to have sufficient length, function, adequate blood supply and innervation due to a short digital stump being transplanted with the metacarpophalangeal joint. The advantage over a toe transplant consists of the use of digital structures of the hand that are identical in functionality and the anatomy reducing the need for secondary interventions. Conclusion The method of management can be successfully applied for frostbite patients with hand stumps according to indications.

In the northern hemisphere countries, artichoke harvest occurs in winter months; consequently, they are exposed to cold temperatures. This can lead to frost injury, such as triggering the blistering of the cuticle and detachment of outer bracts, which eventually could display brown or black discolouration. This can cause major economic and production losses. As far as we know, no literature is available about this problem in artichokes. Thus, the main aim of this study was to evaluate the effect of total phenolic content and the antioxidant potential of ‘Blanca de Tudela’ artichokes in their capacity to tolerate frost injury when they are exposed to low temperatures. Several factors were analysed, including floral head order, weight and size of artichokes, total phenolic content, phenolic profile and total antioxidant activity. Results showed that tertiary heads, which are the smallest in size, exhibited a greater amount of total phenolic content and antioxidant activity. As a result, these characteristics offered enhanced protection to the artichoke against frosting temperatures. In contrast, the largest artichokes, especially the primary heads, were more susceptible to suffer frostbite. Therefore, artichokes with robust antioxidant systems, characterized by elevated phenolic content, are crucial to reduce their susceptibility to frost injury.

A team of 10 personnel from a mountaineering team has undertaken an expedition to Mt Menthosa at an altitude of 21138 ft. in October 2018. After scaling the peak and in the following days during descent, the three members of the team had developed cold injuries. They were given first aid during descent. Later, they were diagnosed as cases of frostbite. All three personnel were evacuated to a Military Hospital, Delhi, India and were treated with oral vasodilators, antiplatelet drugs, analgesics, and hyperbaric oxygen therapy (HBO2T) was administered at a Recompression chamber at Delhi for 1 week. These personnel were thereafter referred to INHS Asvini for further management and continuation of HBO2T. After 30 sessions of HBO2T administration at this hospital, there was a significant improvement in the wounds of all three personnel with minimal surgical intervention and no major amputation. The treatment of frostbite includes treating hypothermia before thawing of cold injury, nonsteroidal anti-inflammatory drugs, antibiotics, tissue plasminogen activators and iloprost, a potent vasodilator which is used in severe cases. Planning of surgery is vital with the goal of obtaining the best functional outcome. Premature amputation increases morbidity and is likely to lead to poor subsequent function. This article aims to discuss the advantages of HBO2T administration as an adjuvant therapy in the management of frostbite cases along with wound care management.

Frostbite is a localized cold thermal injury, as a result of tissue exposure to temperatures below freezing point for a prolonged period of time. The spectrum of injury is broad; thus, frostbite injuries may have deleterious effects with the possibility of losing part or whole extremities. We aim to present the case of a 38-year-old male patient evaluated with multiphase technetium-99m-methylene diphosphonate bone scintigraphy. This methodology may accelerate clinical management of frostbite injuries because it provides precise clinical-imaging correlation by determining the extent of injury and can accurately predict the level of amputation if required. [ABSTRACT FROM AUTHOR]

Simple Summary: In its indigenous South American habitats, the coypu (Myocastor coypus) is exposed to milder climatic conditions than in most European countries. Owing to the good adaptability of this invasive species, the coypu has spread to regions with other climate zones. After the last severe frost period in February 2021 in Lower Saxony, Germany, several coypus with uncommon skin injuries were harvested. In this period, ground temperatures below −10° Celsius were recorded for approximately two consecutive weeks. The chronological sequence led to the assumption of frostbite injuries. The sampled animals consisted of five female and five male individuals. Post mortem examination revealed ulcerative to necrotizing lesions located predominantly on the tail and/or limbs. The cause of the lesions could not be determined with certainty. However, considering the local weather conditions and the distribution of lesions, frostbite has to be considered as the most likely cause. Native to South America, the coypu (Myocastor coypus) is an invasive alien species (IAS) of Union concern. It was introduced to Germany a hundred years ago and is considered established in all German federal states. Between January and February 2021, ground temperatures below −10° Celsius were recorded in Lower Saxony, Germany, for approximately two consecutive weeks. Five male and five female coypus, harvested between 23 February and 31 March 2021, received a post-mortem examination. Nutritional status was poor in six cases, moderate in three and good in one case. Pregnancy was observed in two females. In all the animals, lesions were predominantly found on the distal limbs (n = 7) and/or tail (n = 10), involving the skin and soft tissue with occasional exposure or loss of bones. The histological findings consisted of chronic, ulcerative to necrotizing dermatitis and occasional ulcerative-suppurative dermatitis, necrotizing myositis, thrombosis, granulation tissue, fibrosis and intralesional dystrophic mineralization. Intralesional bacteria were present in six and fungal spores in one animal. Determination of the exact cause was not possible; however, considering the local weather conditions and the distribution of lesions, frostbite injuries have to be considered as the most likely cause. The intralesional bacteria and fungal spores most likely represent secondary contaminants. Interestingly, lesions of this kind have not been reported in coypus in Germany so far. Therefore, frostbite should be considered as a potential cause of disease in coypus, warranting further investigation. [ABSTRACT FROM AUTHOR]

Objectives: Frostbite refers to the freezing of body tissue which is caused by prolonged exposure to cold temperatures and results in tissue destruction. Tissue damage is due to both immediate cold-induced cell death and the more gradual development of localized inflammatory processes and tissue ischemia. A detailed treatment plan based on the current UpToDate literature is needed to decrease morbidity and mortality rates.Methods: The United States National Library of Medicine (PubMed/Medline), EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews were systematically searched to identify publications relevant to this review.Conclusion: In this review, we present the current knowledge on the diagnosis and treatment of frostbite injuries. We then provide an extended and detailed treatment plan, from first aid in the field to treatment of short and long-term complications . [ABSTRACT FROM AUTHOR]

Background: Frostbite is a severe thermal injury, which characterized by tissue necrosis with a high percentage of amputations, disability of patients.Methods: According to the databases Web of Science, Google Scholar, PubMed, E-library down to 2001-2021 the search for works related to the problem of diagnosis, treatment of frostbite of the upper extremities was made. Actual possibilities of diagnostics, the questions of classification, treatment of frostbite, including the features of plastic surgery operations used to close hand defects after excision of necrotic tissues have been analyzed.Results: Frostbite is more common in people with alcohol dependence, mental illness and in socially disadvantaged groups. The most informative instrumental methods of diagnosis: bone scintigraphy, magnetic resonance imaging, single-photon emission computed tomography. Thrombolytic therapy (tPA) and prostacyclin are most effective if used within the first day after tissue rewarming. With deep frostbite and late medical care surgical treatment is fundamental. Amputation and debridement are carried out after the formation of the demarcation line. To replace soft tissue defects that extend beyond the fingers, it is preferable to use fasciocutaneous flaps.Conclusion: The defining moments in the treatment of deep frostbite are timely diagnosis and complex treatment. With late admission surgical treatment, including reconstructive skin plastic surgery, becomes important. [ABSTRACT FROM AUTHOR]

Magnan, Dre Marie-Anne, Marco Gelsomino, Pierre Louge, and Rodrigue Pignel. Successful delayed hyperbaric oxygen therapy and iloprost treatment on severe frostbite at high altitude. High Alt Med Biol. 23:294–297, 2022.―Frostbite is an injury caused when tissues freeze. Severe frostbite can result in amputation. Hyperbaric oxygen therapy (HBO) may improve frostbite outcome. The patient, a 36-year-old man, was climbing above 6,000 m in Kyrgystan when he fell into a crevasse and lost his gloves. The outside temperature was −30°C. He sustained grade 3 frostbite of both hands, which carries a high amputation risk. He was rescued by local responders and transported to the local hospital: neither rapid rewarming in warm water nor other specific frostbite treatment was given. The patient was repatriated to Geneva (day 2). On day 3, he received medical care including iloprost infusion for 7 days and daily HBO for 3 weeks. His hands healed in <1 month. He suffered no amputation. At 6-month follow-up, no early arthritis was found. Three years later he was able to climb again and play volleyball. He still does not have any clinical arthritis at 4-year follow-up. Iloprost is less effective when initiated longer than 48 hours after frostbite injury. Despite the delay, the patient did not require amputation, as might have been predicted by the injury. The combination of HBO and iloprost may have contributed to this favorable outcome. [ABSTRACT FROM AUTHOR]

Deep feet frostbite is a severe trauma and often leads to amputation due to full-thickness skin necrosis and subcutaneous tissue damage. A retrospective analysis was performed between June 2013 and June 2019 to review the management measures and outcomes of clinical treatment, and available data had been collected including demographic characteristics, risk factors, and injury environment record. Treatment protocols, wound management, and outcomes were also presented. There were 36 patients diagnosed with deep feet frostbite with a mean age of 51.5 years; the ratio for male to female is 5:1. Drunk and mental disorders were the main risk behaviors for frostbite occurrence. As for the injury environment, mean temperature and wind speed were −20.5 °C and 3.3 m/s, respectively. Fourteen cases achieved wound healing without surgery intervention, 5 cases received skin graft, and 17 cases received amputation. Most amputations (12 cases) were restricted at toe level; only 1 case received whole feet amputation. Our finding indicated that feet deep frostbite in our hospital showed a male predominant and older age including various risk behaviors and coexistence risk factors. Clinical management based on pathology mechanism needs further improvement, as the amputation rate was still high. How to avoid amputation and lower the amputation level are the focus of future efforts. [ABSTRACT FROM AUTHOR]

Hydrogel has emerged as a promising wound dressing material, and in situ forming hydrogel has emerged as a promising wound dressing recently. But most in situ forming hydrogel are normally unstable. Herein, we report an in-situ forming hydrogel synthesized from poly(Nisopropylacrylamide166- co - n -butyl acrylate9)-poly(ethyleneglycol)-poly(N-isopropylacrylamide166- co - n -butyl acrylate9) copolymer (P(NIPAM166- co -nBA9)-PEG-P(NIPAM166-conBA9), denoted as PEP) and zinc oxide nano-particle(ZnO nano-particle) in response to skin temperature. This thermoresponsive hydrogel exhibits sol-gel reversibility at high temperatures, which is closed to the temperature of human skin. To investigate its healing effects, we used the Hydrogel dressing® in an SD rat model. The biocompatibility and antibacterial ability against methicillin-resistant Staphylococcus aureus(MRSA) of this PEP-ZnO hydrogel wound dressing are confirmed in vitro and in vivo, which could transparently promote the healing of a MRSA-infected frostbitten skin Injury., Materials and Methods: Thirty rats were randomly divided into two groups. The treatment group received hydrogel and transparent film dressing 30 min to 1 h post-burn, while the control group received only cotton dressing. The wound area was measured, and the wound closure rate was calculated on days 3, 7, and 14 post-surgery. Tissue samples were collected from each rat on these days and stored at -80 °C for histological analysis using H&E, Masson and immunohistochemical staining. This analysis assessed factors such as granulation tissue length, re-epithelialization, re-angiogenesis, collagen deposition, inflammatory cell infiltration, and collagen production. Clinical and histological assessments at 14 days showed more rapid healing in the hydrogel dressing group compared to the control group., Conclusion: Our results indicate that the design of our hydrogel for cooling injury wounds effectively improves healing and mitigates the damage from low temperatures., Competing Interests: All authors disclosed no relevant relationships., (© 2024 The Author(s). Published by Elsevier BV on behalf of The Japanese Society for Regenerative Medicine.)

Cold associated foot injuries, such as frostbite and trench foot (immersion foot) are relatively common in cold environments. The former is classified as a freezing cold injury, and the latter as a nonfreezing cold injury. Trench foot is sometimes misdiagnosed as frostbite, and rapid rewarming exacerbates the condition. This paper aims to help differentiate between frostbitten foot and trench foot. This study included patients with frostbitten foot or trench foot treated at our hospital between December 2005 and May 2023. The differences in sex, age, month of injury, conditions at the time of injury, injury distribution, foot lesion laterality, other complications upon arrival (finger frostbite, immersion hand, or hypothermia), and presence and distribution of sensory disturbance at discharge were noted among the groups. A total of 16 patients (14 men) with frostbitten foot and 3 patients (3 men) with trench foot were identified. Finger frostbite observed in nine and zero patients with frostbitten foot and trench foot, respectively; and severe hypothermia on arrival observed in five and zero patients with frostbitten foot and trench foot, respectively. Physical findings at the initial examination showed that the frostbitten feet were dry, and the lesions were distal and clearly demarcated, whereas feet with trench foot were wet, and the lesions covered the entire sole and were not clearly demarcated. Accurate differentiation between frostbitten foot and trench foot and appropriate initial treatment are important. The presence of finger frostbite, immersion hand or severe hypothermia may help to differentiate between frostbitten foot and trench foot., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Frostbite is defined as tissue damage that is sustained as a result of prolonged exposures to less than 0°C resulting in ice crystallisation, microvascular occlusion and subsequently thrombosis., Case: A 33-year-old mountaineer with cold burn over 20% of the total body surface area with eschar formation, acute renal failure, upper limb venous thrombosis and bilateral pleural effusion. We hereby report a successful anaesthetic management of this patient undergoing debridement and escharotomy for frostbite injuries and review its perioperative concerns., Conclusion: Frostbite injuries pose a challenge to the anaesthetic team due to the multi-systemic nature of its involvement., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Frostbite, a severe cold injury resulting from exposure to subfreezing temperatures, damages the skin and underlying tissues of the affected area and ranges in severity from first to fourth degree. This case report investigates the impact of second-degree frostbite suffered by a marine during winter training on cold-induced vasodilation (CIVD). Comparisons of CIVD before and after the injury revealed significant alterations in CIVD responses. CIVD, a physiological mechanism characterized by blood vessel dilation in response to cold exposure, plays a crucial role in operating in cold-weather environments and enhancing dexterity. The marine exhibited prolonged CIVD onset time, lower finger temperatures, increased pain sensations, and diminished dexterity after the frostbite injury during follow-up CIVD testing. The findings suggest that the frostbite-induced damage possibly compromised the microvascular function, contributing to the observed changes in CIVD. The marine reported persistent cold sensitivity and difficulty in maintaining hand warmth when assessed postinjury. This case underscores the potential long-term consequences of frostbite on CIVD and manual dexterity, emphasizing the importance of understanding these physiological changes for individuals engaged in cold-weather activities, particularly for military and occupational personnel., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Frostbite in Southwestern China has been overlooked due to its low incidence, relatively mild temperature and lack of literature published before. However, it needs to be further studied for religious diversity and distinct geomorphology. In this article, we reported an 18-year-old Tibetan girl who suffered from blizzard attack during pilgrimage. Her feet and several fingers showed mummified gangrene upon physical examination with poor movement. She was diagnosed with 3rd to 4th degree of frostbite. The girl was given oral ibuprofen, debridement and other regular treatment daily, but she was eventually amputated due to insufficient thrombolytic management in primary hospital, delayed informing consent in the referral hospital and ethnic conflict between religion and guidelines. This case enriched the experience of managing complex frostbite in Tibetan population and alarms that efforts should be integrated to protect pilgrims and mountaineers in the Tibetan region.

Although hypothermia and cold injuries are rare in children and young people in the UK, the risk is persistent and requires urgent medical management when it does occur. This article outlines some considerations for professionals who may be caring for hypothermic patients or those at risk of becoming hypothermic. [ABSTRACT FROM AUTHOR]

In this study, we extended our previously developed anatomically detailed three-dimensional (3-D) thermoregulatory virtual human model for predicting heat stress to allow for predictions of heat and cold stress in one unified model. Starting with the modified Pennes bioheat transfer equation to estimate the spatiotemporal temperature distribution within the body as the underlying modeling structure, we developed a new formulation to characterize the spatial variation of blood temperature between body elements and within the limbs. We also implemented the means to represent heat generated from shivering and skin blood flow that apply to air exposure and water immersion. Then, we performed simulations and validated the model predictions with experimental data from nine studies, representing a wide range of heat- and cold-stress conditions in air and water and physical activities. We observed excellent agreement between model predictions and measured data, with average root mean squared errors of 0.2°C for core temperature, 0.9°C for mean skin temperature, and 27 W for heat from shivering. We found that a spatially varying blood temperature profile within the limbs was crucial to accurately predict core body temperature changes during very cold exposures. Our 3-D thermoregulatory virtual human model consistently predicted the body's thermal state accurately for each of the simulated hot and cold environmental conditions and exertional heat stress. As such, it serves as a reliable tool to assess whole body, localized tissue, and, potentially, organ-specific injury risks, helping develop injury prevention and mitigation strategies in a systematic and expeditious manner. [ABSTRACT FROM AUTHOR]

Frostbite is a high morbidity injury caused by soft tissue freezing, which can lead to digit necrosis requiring amputation. Rapid rewarming is a first-line treatment method that involves placing affected digits into a warm water bath. This study aims to assess the clinical practices for frostbite at facilities outside of dedicated burn centers, and any impact these practices have on tissue salvage. Retrospective chart review at a single burn center identified frostbite patients admitted directly or as transfers over a 7-year period. Records were reviewed to identify initial treatment strategies. If given, time to thrombolytics from admit was noted. Tissue salvage rates were calculated from radiologically derived tissue at-risk scores and final amputation scores. One-hundred patients were transferred from outside facilities, and 108 were direct admissions (N = 208). There was no significant difference in group demographics. Rapid rewarming was the initial treatment modality more commonly in direct admit patients (P = .016). The use of rapid rewarming did not correlate with tissue salvage (P = .112). Early use of thrombolytics had a positive impact on tissue salvage (P = .003). Thrombolytics were given 1.2 hours earlier in direct admit patients (P = .029), however there was no difference in tissue salvage rates between the groups (P = .127). Efforts should focus on larger scale study to further assess the effectiveness of rapid rewarming. Although rapid rewarming did not significantly impact tissue salvage in this study, we continue to recommend its use over less studied treatment methods, and continue to view it as an important bridge to burn center transfer and administration of thrombolytic therapy. [ABSTRACT FROM AUTHOR]

Background: COVID toes or chilblain-like skin lesions have been widely reported during COVID-19 pandemic. Most cases were described in patients with negative microbiological tests for SARS-CoV-2, therefore the possible relationship with SARS-CoV-2 infection, as well as with the nowadays broadly available mRNA-based vaccination, has not been fully elucidated. Case presentation: We here describe the case of a 14-year-old male who developed chilblain-like skin eruptions during SARS-CoV-2 infection despite two mRNA-based vaccine doses and review the clinical and epidemiological characteristics of chilblain-like lesions as a cutaneous presentation of COVID-19 in children. Conclusions: Most children and adolescent with COVID toes have a mild or asymptomatic SARS-CoV-2 infection. Our report aims to highlight the possible onset of these skin lesions in vaccinated children, if infection has occurred, and the potential use of systemic corticosteroids as a first line treatment. Additional evidence is required to better understand SARS-CoV-2 infection and cutaneous manifestations in children and determine the relationship between chilblain-like lesions and COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

The article reviews the diagnosis and treatment of frostbite. It identifies the four-level classification schemes for frostbite and describes its pathophysiology and epidemiology. It offers guidelines for the prevention and initial care of frostbite and outlines in-hospital treatment and management of patients with frostbite including the use of ilosoprost, thrombolysis and catheter-directed thrombolysis. The rehabilitation and aftercare of patients is discussed.

Davis, Ashlee, Brent Sinopoli, Nathaniel Mann, and Antine E. Stenbit. A photographic case of frostbite treated with delayed hyperbaric oxygen therapy. High Alt Med Biol. 23:194–197, 2022.—A 50-year-old female presented to the emergency department in June 2019 5 days after summiting Denali. Temperature on summit day was −25°F, and she developed frostbite on multiple digits of both hands. Eight digits demonstrated severe frostbite based on the grading set forth by Cauchy et al. Five of these had grade III injuries. She received three hyperbaric dives in Alaska before flying to her home state. On day 5 she received aspirin, aloe wraps, and underwent twenty-seven 90-minute dives at 2 atmospheres absolute. Unique in current literature, each dive was accompanied by photographs detailing clinical progression, which may assist providers in providing expectations in care. She eventually underwent amputation at, or distal to, the distal interphalangeals of bilateral third and fourth digits and the left fifth digit. By January 2020, she had returned to near-normal range of motion. Hyperbaric oxygen therapy represents a potential adjunct therapeutic option for frostbite, even in delayed manner, but its use as a treatment modality warrants further prospective analysis. [ABSTRACT FROM AUTHOR]