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Acta Chir Belg 2020 Jul 1:1-4. Epub 2020 Jul 1.

Traumasurgeon, Haaglanden Medical Centre, Den Haag, The Netherlands.

In recent years nitrous oxide has become a popular party drug. Large cylinders filled with nitrous oxide are used to fill balloons for recreational use. We present two patients with severe third-degree cold burns on their thighs after clamping a large cylinder between their legs while filling balloons. Read More

Burns 2020 May 16. Epub 2020 May 16.

Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.

J Burn Care Res 2020 Jun 9. Epub 2020 Jun 9.

Director - University Medical Center - New Orleans, Surgery, Louisiana State University Health Sciences Center.

Introduction: Burn care and medical education have undergone dramatic changes. Trauma has over 7 courses covering fundamentals, while burns has one. Our goal was to develop a course to meet the needs of healthcare professionals requiring more advanced burn management training. Read More

Wilderness Environ Med 2020 May 29. Epub 2020 May 29.

University of Utah, Division of Emergency Medicine, Salt Lake City, UT.

Introduction: Cold-induced vasodilation (CIVD) is seen in the extremities during exposure to cold. A strong vasodilation response has been associated with a decreased risk of cold injury. Increasing CIVD might further decrease this risk. Read More

Pediatr Dermatol 2020 05;37(3):441

Dr DY Patil University, Pune, India.

Ned Tijdschr Geneeskd 2020 Apr 16;164. Epub 2020 Apr 16.

Rode Kruis Ziekenhuis, afd. Brandwondencentrum, Beverwijk.

Background: There is a new type of injury that is observed increasingly often: frostbite of the thighs that has occurred as result of holding a cylinder containing nitrous oxide in position between the legs during recreational use of said substance. Because skin symptoms are often mild in the first few days after the event, the severity of the injury is often not recognized. However, patients can suffer serious scarring from this type of injury. Read More

Int J Dermatol 2020 06 8;59(6):748. Epub 2020 May 8.

Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.

Burns Trauma 2020 10;8:tkaa008. Epub 2020 Apr 10.

Department of Surgery, Maine Medical Center, 22 Bramhall St, Portland, Maine 04102, USA.

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. Read More

J Am Acad Dermatol 2020 Jul 24;83(1):e61-e63. Epub 2020 Apr 24.

Dermatology Department, Ramon y Cajal University Hospital, Irycis, Madrid, Spain.

Curr Mol Med 2020 Apr 6. Epub 2020 Apr 6.

Dept. Cell and Molecular Physiology, Loyola University Chicago, Health Sciences Division, Maywood, IL. United States.

Background: Frostbite injury results in serious skeletal muscle damage. The inflammatory response due to frostbite causes local muscle degeneration. Previous studies have shown that the heat shock proteins (hsps) are able to protect against inflammation. Read More

Int J Circumpolar Health 2020 12;79(1):1749001

Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

To characterise cold sensitivity using a semi-structured interview, physical examination, thermal quantitative sensory testing (QST), and laser speckle contrast analysis (LASCA). Eight women and four men, ages 22-74, with cold sensitivity were interviewed and examined by an occupational physician. Thermal perception thresholds were established using QST, on the pulp of the index and little finger of the most affected hand. Read More

Am Fam Physician 2020 Apr;101(7):440-442

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Plast Reconstr Surg 2020 04;145(4):874e-875e

Plast Reconstr Surg 2020 04;145(4):874e

J Burn Care Res 2020 Jul;41(4):919

Yukon-Kuskokwim Delta Regional Hospital, Bethel, Alaska.

J Burn Care Res 2020 Mar 3. Epub 2020 Mar 3.

Medical Director, Sumner Redstone Burn Center Massachusetts General Hospital, Boston, MA Assistant Professor Harvard Medical School Boston, MA.

Existing burn center referral criteria were developed several years ago, and subsequent innovations in burn care have occurred. Coupled with frequent errors in estimation of extent of burn injury and depth by referring providers, patients are both over and under-triaged when the existing criteria are used to support patient care decisions. In the absence of compelling clinical trial data on appropriate burn patient triage, we convened a multi-disciplinary panel of experts to execute an iterative eDelphi consensus process to facilitate a revision. Read More

Zhonghua Shao Shang Za Zhi 2020 Feb;36(2):117-121

Department of Burn Surgery, the First Hospital of Jilin University, Changchun 130021, China.

To explore the effects of recombinant human granulocyte macrophage colony stimulating factor (rhGM-CSF) gel on treatment of thefull-thickness frostbite wounds on foot and hand. From November 2013 to April 2017, a total of 45 patients of 71 full-thickness frostbite wounds on foot and hand meeting the inclusion criteria were admitted to the First Hospital of Jilin University and the prospective randomized controlled study was done. The patients were divided into rhGM-CSF group of 24 patients with 35 wounds and control group of 21 patients with 36 wounds according to the random number table. Read More

J Tissue Viability 2020 May 30;29(2):110-115. Epub 2020 Jan 30.

Department of Burns, The First Hospital of Jilin University, Changchun, 130021, China. Electronic address:

Objective: To investigate the clinical characteristics and treatment outcomes in patients with severe frostbite in a single institution in northeastern China.

Methods: The clinical records of patients with severe frostbite of the extremities who were hospitalized at the authors' institution between January 2009 and April 2019 were retrospectively reviewed. Demographic data, predisposing factors, clinical presentation, duration of signs and symptoms, number of surgical interventions, and length of hospital stay were extracted and analyzed. Read More

J Health Care Poor Underserved 2020 ;31(1):441-454

We assessed the ability of high-risk criteria developed by Boston Health Care for the Homeless Program to identify increased mortality during a 10-year cohort study (January 2000-December 2009) of 445 unsheltered adults. To qualify as high-risk for mortality, an individual slept unsheltered for six consecutive months or longer plus had one or more of the following characteristics: tri-morbidity, defined as co-occurring medical, psychiatric, and addiction diagnoses; one or more inpatient or respite admissions; three or more emergency department visits; 60 years old or older; HIV/AIDS; cirrhosis; renal failure; frostbite, hypothermia, or immersion foot. A total of 119 (26. Read More

J Burn Care Res 2020 May;41(3):722-726

Department of Surgery.

Frostbite injuries are uncommon, understudied, and lack standardized treatment protocols. Although thrombolytics are commonly used, their efficacy remains controversial. Herein, we report the results of a retrospective review of frostbite treatment practices at a single institution. Read More

Zhonghua Shao Shang Za Zhi 2020 Jan;36(1):9-13

Department of Burn Surgery, the First Hospital, Jilin University, Changchun 130021, China.

Cold injury is very damaging. This article summarizes the mechanism, types, and rehabilitation of cold injury, focusing on the degree and clinical treatment of frostbite. Frostbite can mainly cause damage of microcirculation and capillary structure, while burn injury can mainly cause damage of cutaneous tissues. Read More

AJR Am J Roentgenol 2020 04 5;214(4):930-937. Epub 2020 Feb 5.

Department of Radiology, Boston Medical Center, 820 Harrison Ave, FGH Bldg, 3rd Fl, Boston, MA 02118.

The purpose of this study is to review the various techniques and clinical management paradigms using tissue plasminogen activator (tPA) to treat severe frostbite injuries, which are relevant to the interventional radiologist. A literature search yielded 157 citations, which were manually screened for inclusion criteria of case reports, case series, cohort studies, and randomized prospective studies that reported the use of tPA to treat severe frostbite injuries, of which 16 qualified for review. Data extracted from the studies included authors, journal, year of publication, initial assessment and management of severe frostbite injuries, inclusion and exclusion criteria for tPA therapy, treatment and control group size, different imaging modalities used in evaluation of severe frostbite injuries, tPA treatment protocols, outcomes, and side effects or complications. Read More

J Burn Care Res 2020 Feb 1. Epub 2020 Feb 1.

Attending doctor, Department of Burn Surgery, The First Hospital of Jilin University, Chaoyang District, Changchun, Jilin Province, China.

The aim of the study was to investigate the effects of the rhGM-CSF gel on third degree frostbite wounds. 62 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 was used to measure outcomes respectively. Read More

Cryobiology 2020 Feb 17;92:203-207. Epub 2020 Jan 17.

Department of Interventional Therapy, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, 518035, China. Electronic address:

This study aimed to evaluate the safety and effectiveness of CT-guided percutaneous cryoablation for treatment of painful osteolytic bone metastases. A total of 26 patients (36 bone metastases) treated with CT-guided percutaneous cryoablation between May 2012 and June 2016 were enrolled in this retrospective study. All procedures were performed under local anesthesia. Read More

Mar Drugs 2020 Jan 11;18(1). Epub 2020 Jan 11.

State Key Laboratory of Microbial Technology, Institute of Marine Science and Technology, Marine Biotechnology Research Center, Shandong University, Qingdao 266237, China.

Many marine microorganisms synthesize exopolysaccharides (EPSs), and some of these EPSs have been reported to have potential in different fields. However, the pharmaceutical potentials of marine EPSs are rarely reported. The EPS secreted by the Artic marine bacterium sp. Read More

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2019 Dec;37(12):937-939

Shandong Academy of Occupational Healthy Occupational Medicine, Shandong First Medical University &Shandong Academy of Medical Sciences, Jinan250002, China.

The diagnosis, treatment, operation and diagnosis of two cases of occupational frostbite diagnosed in Shandong Academy of Occupational Healthy Occupational Medicine were analyzed retrospectively. In these two patients working in a low temperature environment, the finger frostbite did not arouse enough attention, one patient did not receive timely diagnosis and treatment, and one patient received timely medical treatment, but did not receive proper treatment, which ultimately led to the adverse consequences of finger amputation. The staff under the low temperature environment should strictly carry out the low temperature operation protection standard and improve their self-protection consciousness. Read More

BMC Public Health 2020 Jan 13;20(1):46. Epub 2020 Jan 13.

Department of Epidemiology, University of Washington, Seattle, WA, USA.

Background: The increasing adoption of electronic health record (EHR) systems enables automated, large scale, and meaningful analysis of regional population health. We explored how EHR systems could inform surveillance of trauma-related emergency department visits arising from seasonal, holiday-related, and rare environmental events.

Methods: We analyzed temporal variation in diagnosis codes over 24 years of trauma visit data at the three hospitals in the University of Washington Medicine system in Seattle, Washington, USA. Read More

J Burn Care Res 2020 Jan;41(1):176-183

Department of Surgery, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, North Carolina.

The data are insufficient to support standardized treatment of all patients with frostbite with thrombolytic therapy. The following guidelines, however, should be applied to all patients with cyanosis persisting proximal to the distal phalanx (Grade 3 or 4 frostbite injury) and demonstrated loss of perfusion at or proximal to the middle phalanx immediately after rewarming. Read More

Zhonghua Shao Shang Za Zhi 2019 Dec;35(12):866-871

Department of Burns, Tongren Hospital of Wuhan University & Wuhan Third Hospital, Wuhan 430060, China.

To analyze application and funding projects of National Natural Science Foundation of China (NSFC) in the discipline of burns and plastic surgery over the years, so as to provide reference for subsequent fund application and the search for new research directions in the discipline. Annual statistical reports on funding projects and Internet-based Science Information System of NSFC were used to search the application and funding situation of the science foundation projects related to the discipline of burns and plastic surgery during 1986-2018. The relevant situation was statistically analyzed during 2009-2018, including the amount of applications and grant, funding rate, and appropriation. Read More

Lancet 2020 12;394(10216):2282

Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

Support Care Cancer 2020 Aug 6;28(8):3691-3699. Epub 2019 Dec 6.

The N.1 Institute for Health, National University of Singapore, Singapore, Singapore.

Purpose: Severe peripheral neuropathy is a common dose-limiting toxicity of taxane chemotherapy, with no effective treatment. Frozen gloves have shown to reduce the severity of neuropathy in several studies but comes with the incidence of undesired side effects such as cold intolerance and frostbite in extreme cases. A device with thermoregulatory features which can safely deliver tolerable amounts of cooling while ensuring efficacy is required to overcome the deficiencies of frozen gloves. Read More

Vasa 2020 Mar 6;49(2):133-140. Epub 2019 Dec 6.

Department of Vascular Diseases, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.

Idiopathic chilblain is a relatively common yet poorly recognized acrosyndrome. This literature review aims to better understand and draw attention to this disorder. Chilblain is a localized inflammation of the skin that occurs on exposure to cold but non-freezing wet weather. Read More

MSMR 2019 Nov;26(11):17-26

From July 2018 through June 2019, a total of 513 members of the active (n=446) and reserve (n=67) components had at least 1 medical encounter with a primary diagnosis of cold injury. The crude overall incidence rate of cold injury for all active component service members in 2018-2019 (36.5 per 100,000 person-years [p-yrs]) was slightly higher than the rate for the 2017-2018 cold season (35. Read More

Am Fam Physician 2019 12;100(11):680-686

Evans Army Community Hospital, Fort Carson, CO, USA.

Hypothermia, frostbite, and nonfreezing cold injuries predominantly affect older adults, homeless or intoxicated people, adventurers, and military personnel. Prevention begins with clothing that is clean, layered, and loose to promote circulation. Base layers made of moisture-wicking materials are favored over wool or cotton. Read More

Wounds 2019 Dec 30;31(12):322-325. Epub 2019 Sep 30.

Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Introduction: Frostbite is well documented in the military and countries with extreme temperatures, and it is most likely due to increased exposure to cold temperatures and/or risk-taking behavior. Severity of injury depends on absolute temperature, wind chill, duration of exposure, wet or dry cold, immersion, clothing quality, and substance use. Hyperbaric oxygen therapy (HBOT) has been described as a treatment option but only in small case series. Read More

Wounds 2020 Jan 31;32(1):22-29. Epub 2019 Oct 31.

Milliken Healthcare Products, Spartanburg, SC.

Introduction: Frostbite is well documented in the military and countries with extreme temperatures, and it is most likely due to increased exposure to cold temperatures and/or risk-taking behavior. Severity of injury depends on absolute temperature, wind chill, duration of exposure, wet or dry cold, immersion, clothing quality, and substance use. Hyperbaric oxygen therapy (HBOT) has been described as a treatment option but only in small case series. Read More

Isr Med Assoc J 2019 Nov;21(11):761-762

Department of Internal Medicine C, Sheba Medical Center, Tel Hashomer, Israel.

Foot (Edinb) 2019 Sep 20;40:109-115. Epub 2019 Aug 20.

NYU Langone Medical Center, United States; NYU Langone Brooklyn-Chief of Podiatry, United States.

The use of single photon emission computer tomography (SPECT/CT) in acute vascular injury is not well documented. SPECT/CT combines the anatomic detail of computer tomography with the functional vascular perfusion of photon emission to determine the viability of osseous structures and surrounding soft tissue. The superimposed imaging provides the practitioner with a reliable anatomic image of viability of a specific anatomic area following insult or injury. Read More

Appl Ergon 2020 Jan 8;82:102964. Epub 2019 Oct 8.

Division of Environmental Physiology, Swedish Aerospace Physiology Center, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Berzelius väg 13, SE-171 65, Solna, Sweden.

The purpose was to evaluate whether a cold-water immersion test could be used to identify individuals susceptible to local cold injuries (LCI). Sixty-five healthy non-injured (N-I) subjects, and fifteen subjects, who were tested either prior to or after a LCI, sequentially immersed one hand and one foot, in 8 °C water for 30 min (CWI phase); this was followed by 15 min of spontaneous rewarming (RW phase). The LCI group showed a lower toe temperature during the CWI phase, and a lower maximum RW temperature of the fingers than the N-I group. Read More

Undersea Hyperb Med 2019 Jun-Jul-Aug - Third Quarter;46(4):521-526

Utah Valley Hospital, Hyperbaric Medicine and Wound Care, Intermountain HealthCare, Provo, Utah.

While several published cases have reported tissue preservation with hyperbaric oxygen (HBO2) after frostbite, its routine use is not endorsed by expert consensus. We report a case of possible frostbite injury to the toes of both feet and the plantar surface of the left foot in a 17-year-old male patient. The exposure history included two episodes of rewarming followed by refreezing in the field during a hike through knee-deep snow without adequate clothing. Read More

J Dairy Sci 2019 Nov 30;102(11):10606-10615. Epub 2019 Aug 30.

Department of Veterinary Population Medicine, University of Minnesota, St. Paul 55108.

The objective of this study was to evaluate the effects of 2 winter (December to April) housing systems on dairy cow hygiene scores, frostbite, teat condition, clinical mastitis, and activity and rumination across 3 winter seasons (2013, 2014, and 2015). Certified-organic cows (n = 268) were randomly assigned to 2 treatments (2 replicates per system): (1) outdoor straw pack (outdoor) or (2) 3-sided compost-bedded pack barn (indoor). Cows calved during 2 seasons (spring or fall) at the University of Minnesota West Central Research and Outreach Center, Morris, Minnesota, organic dairy. Read More

Biol Pharm Bull 2019 ;42(8):1409-1414

Department of Drug Delivery Research, Hoshi University School of Pharmacy and Pharmaceutical Sciences.

In the present study, a novel wound dressing made of xyloglucan (Xyl)-sucrose (Suc) hydrogel was developed for the treatment of deep wounds including pressure ulcers. The dressing was prepared by casing an aqueous solution of Xyl and sugar and then warming, and a hydrogel sheet was obtained. The in vitro characteristics of these sheets, such as their strength, extensibility, water content, adhesion potential, and water absorption, were examined. Read More

Wilderness Environ Med 2019 Dec 17;30(4S):S19-S32. Epub 2019 Jul 17.

Division of Emergency Medicine, Altitude Research Center, University of Colorado Denver School of Medicine, Denver, CO; Institute for Altitude Medicine, Telluride, CO.

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Read More

J Burn Care Res 2019 08;40(5):566-569

Hennepin Healthcare, Minneapolis, MN.

Assessment of frostbite injury typically relies on computed tomography, angiography, or nuclear medicine studies to detect perfusion deficits prior to thrombolytic therapy. The aim of this study was to evaluate the potential of a novel imaging method, microangiography, in the assessment of severe frostbite injury. Patients with severe frostbite were included if they received a post-thrombolytic Technetium 99 (Tc99) bone scan, a Tc99 bone scan without thrombolytic therapy, and/or post-thrombolytic microangiography (MA) study. Read More

Temperature (Austin) 2019 22;6(2):142-149. Epub 2019 Feb 22.

Department of National Defence, Toronto Research Centre, Research and Development, Toronto, ON, Canada.

A cold-induced vasodilation (CIVD) test was administered to 113 Canadian Armed Forces (CAF) soldiers (age 25.6 ± 6 yrs) during pre-deployment to a Canadian Arctic training exercise. The incidence and rates/types of subsequent peripheral cold injuries, as well as the relationship of CIVD responses against other hypothesized/reported risk factors (smoking, gender, age, ethnicity and prior cold injury), were analyzed. Read More

J Burn Care Res 2019 10;40(6):907-912

Burn Unit, University of Montreal Hospital Centre, Montreal, Canada.

Frostbite causes tissue damage through five major mechanisms, out of which two are amenable to treatment. The first-line treatment is rapid rewarming therapy using water at 40°C to 42°C, which addresses the formation of ice crystals in the intra and extra cellular compartments. The second mechanism is progressive tissue ischemia after rewarming and is only accessible to a second-line therapy represented by thrombolysis. Read More

Air Med J 2019 Jul - Aug;38(4):248-250. Epub 2019 Apr 19.

J Burn Care Res 2019 10;40(6):1012-1014

Department of Plastic Surgery, Hospital Universitario Río Hortega, Valladolid, Spain.

Frostbite is a particularly severe form of cold-induced injury that most frequently causes tissular damage in acral parts (hands and feet) and usually involves a small extension of the TBSA. Here, we present a rare case of frostbite affecting a large area (27%), which was successfully treated in a similar way to a thermal burn injury. Read More

J Prev Interv Community 2020 Jul-Sep;48(3):272-280. Epub 2019 Jun 19.

Department of Psychology, Metropolitan State University, Hudson, Wisconsin, USA.

This quasi-experimental study examined the community and psychosocial benefits in the development of a "green space" environmental project (apple fruit tree orchard) among community residents and inmates in a minimum security prison in St. Paul, MN. Seventeen ( = 17) participants volunteered in the development of an apple tree orchard located on the grounds of a prison facility located in Ramsey County, MN. Read More

J Burn Care Res 2019 08;40(5):541-549

Division of Plastic Surgery, Albany Medical Center, New York.

Frostbite is a cold injury that results in soft tissue loss and can lead to amputation. Vascular thrombosis following injury causes ischemic tissue damage. Despite understanding the pathology, its treatment has remained largely unchanged for over 30 years. Read More