FROSTBITE IN GANGRENE

ROLE OF CLASSIFICATION

Abstract

Objective: The objective of this study is to determine if classification of cases of frost bite in 1st, 2nd,
3rd and 4th degree have any predictive value on the future complications e.g. skin necrosis and gangrene. Study design:
A non-interventional and descriptive study. Place and duration of study: The study was carried out at the Surgical
Department, of Combined Military Hospital Gilgit from January 2002 to February 2005. Material and methods: All the
patients who reported to the hospital with frost bite were admitted and enrolled in the study. The local examination of
wound was done and all the physical signs were recorded. The frost bite was labeled according to the severity from 1st
to 4th degree in accordance to the specified criteria. All the patients were placed on a standard treatment protocol
comprising of injection of Benzyl Penicillin 10 lac U x 6 hourly, injection of Heparin 5000 IU s/c x 6 hourly and tablets
Ibuprofen 400mg x 8 hourly for 5-7 days. The condition of wound was assessed daily till 8 weeks after admission. The
end point of medical treatment was a clear demarcation of dry gangrenous and viable tissue, or the formation of moist
gangrene or infection in frost bitten area which was spreading proximally. Once this condition was reached the patients
were planned for amputation surgery. Results: Total numbers of patients included were 96. Among them 33 had 1st
degree, 37 had 2nd degree, 16 had 3rd degree and 10 had 4th degree frost bite. All the 33 patients of 1st degree frost bite
recovered well and were discharged from the hospital without any surgical intervention. 16 patients among the total 37
who sustained 2nd degree frost bite developed superficial ulcers over the skin. These patients required regular wound
dressings and recovered well by 6 weeks of treatment without any limb loss. 7 out of total 16 patients of 3rd degree and
all the 10 patients of 4th degree frost bite developed gangrenes. They were observed till 8 weeks and after that they
underwent amputations. Conclusion: In accordance to the results it is concluded that most of the patients who had
3rd degree of frostbite and all the patients who sustained 4th degree frost bite developed gangrene by 8 weeks of
hospitalization despite of the treatment. None of the patient of 1st and 2nd degree frostbite developed gangrene. Hence
the initial assessment of a patient was very useful in predicting the chances of development of gangrene.