Affiliation:
1. Department of Surgery, Hennepin County Medical Center (HCMC) , Minneapolis, Minnesota , USA
Abstract
Abstract
Severe frostbite is associated with loss of digits or limbs and high levels of morbidity. The current practice is to salvage as much of the limb/digit as possible with the use of thrombolytic and adjuvant therapies. Sequelae from amputation can include severe nerve pain and poor wound healing requiring revision surgery. The aim of this study was to examine the rate of revision surgery after primary amputation and compare this to revision surgery in isolated hand/foot burns. Frostbite and burn patients from 2014 to 2019 were identified in the prospectively maintained database at a single urban burn and trauma center. Patients with primary amputations related to isolated hand/foot burns or frostbite were included in the study. Descriptive statistics included Student’s t-test and Fisher’s exact test. A total of 63 patients, 54 frostbite injuries and 9 isolated hand or foot burns, met inclusion criteria for the study. The rate of revision surgery was similar following frostbite and burn injury (24% vs 33%, P = .681). There were no significant differences in age, sex, or length of stay on the primary hospitalization between those that required revision surgery and those that did not. Neither the impacted limb nor the presence of infection or cellulitis on primary amputation was associated with future need for revision surgery. Of the 16 patients requiring revision surgery, 5 (31%) required additional debridement alone, 6 (38%) required reamputation alone, and 5 required both. A total of 6 patients (38%) had cellulitis or infection at the time of revision surgery. Time from primary surgery to revision ranged from 4 days to 3 years. Planned, delayed primary amputation is a mainstay of frostbite management. To our knowledge, this is the first assessment of revision surgery in the setting of severe frostbite injury. Our observed rate of revision surgery following frostbite injury did not differ significantly from revision surgery in the setting of isolated hand or foot burns. This study brings up important questions of timing and surgical planning in these complex patients that will require a multicenter collaborative study.
Publisher
Oxford University Press (OUP)
Subject
Rehabilitation,Emergency Medicine,Surgery
Reference30 articles.
1. An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite;Twomey;J Trauma,2005
2. Cold injury;Mohr;Hand Clin,2009
3. Frostbite: experience with rapid rewarming and ultrasonic therapy: part I. 1960;Mills;Alaska Med,1993
4. Effect of rapid and prolonged rewarming on local cold injury;Pichotka;US Armed Forces Med J,1951
5. Effect of inositol and rapid rewarming on extent of tissue damage due to cold injury;Sullivan;Am J Physiol,1957
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