The evolution of the Helsinki frostbite management protocol

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Lindford , A , Valtonen , J , Hult , M , Kavola , H , Lappalainen , K , Lassila , R , Aho , P & Vuola , J 2017 , ' The evolution of the Helsinki frostbite management protocol ' , Burns , vol. 43 , no. 7 , pp. 1455-1463 . https://doi.org/10.1016/j.burns.2017.04.016

Title: The evolution of the Helsinki frostbite management protocol
Author: Lindford, Andrew; Valtonen, Jussi; Hult, Maarit; Kavola, Heli; Lappalainen, Kimmo; Lassila, Riitta; Aho, Pekka; Vuola, Jyrki
Contributor organization: Plastiikkakirurgian yksikkö
Clinicum
Department of Surgery
University of Helsinki
HUS Musculoskeletal and Plastic Surgery
Department of Diagnostics and Therapeutics
Anestesiologian yksikkö
HUS Perioperative, Intensive Care and Pain Medicine
HUS Medical Imaging Center
Hematologian yksikkö
Department of Oncology
HUS Comprehensive Cancer Center
Verisuonikirurgian yksikkö
HUS Abdominal Center
Date: 2017-11
Language: eng
Number of pages: 9
Belongs to series: Burns
ISSN: 0305-4179
DOI: https://doi.org/10.1016/j.burns.2017.04.016
URI: http://hdl.handle.net/10138/298122
Abstract: Background: Severe frostbite can result in devastating injuries leading to significant morbidity and loss of function from distal extremity amputation. The modern day management approach to frostbite injuries is evolving from a historically very conservative approach to the increasingly reported use of early interventional angiography and fibrinolysis with tPA. The aim of this study was to evaluate the results of our frostbite treatment protocol introduced 3 years ago. Methods: All frostbite patients underwent first clinical and then Doppler ultrasound examination. Angiography was conducted if certain clinical criteria indicated a severe frostbite injury and if there were no contraindications to fibrinolysis. Intra-arterial tissue plasminogen activator (tPA) was then administered at 0.5-1mg/h proximal to the antecubital fossa (brachial artery) or popliteal fossa (femoral artery) if angiography confirmed thrombosis, as well as unfractionated intravenous heparin at 500 units/h. The vasodilator iloprost was administered intravenously (0.5-2.0ng/kg/min) in selected cases. Results: 20 patients with frostbite were diagnosed between 2013-2016. Fourteen patients had a severe injury and angiography was performed in 10 cases. The total number of digits at risk was 111. Nine patients underwent fibrinolytic treatment with tPA (including one patient who received iloprost after initial non response to tPA), 3 patients were treated with iloprost alone and 2 patients received neither treatment modality (due to contraindications). The overall digital salvage rate was 74.8% and the Hennepin tissue salvage rate was 81.1%. One patient developed a catheter-site pseudoaneurysm that resolved after conservative treatment. Conclusions: Prompt referral to a facility where interventional radiology and 24/7 laboratory services are available, and the combined use of tPA and iloprost, may improve outcome after severe frostbite. (C) 2017 Elsevier Ltd and ISBI. All rights reserved.
Subject: Cold injury
Thrombolytic therapy
Amputation
Extremity salvage
TISSUE-PLASMINOGEN ACTIVATOR
ACUTE MYOCARDIAL-INFARCTION
HYPERBARIC-OXYGEN
THROMBOLYTIC THERAPY
COLD INJURIES
OPEN-LABEL
EXTREMITIES
EFFICACY
PENTOXIFYLLINE
AMPUTATION
3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: publishedVersion


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