Emerging treatments

Regional nerve block

Sympathectomy has been replaced by the use of iloprost which is a reversible intervention and has a similar effect. Studies have shown promising results for distal volar forearm nerve blocks using lidocaine to create both an analgesic effect and hyperaemia of the affected area. Digital blocks using bupivacaine have been shown to treat both pain and vasoconstriction seen in acute fingertip frostbite, with effects lasting up to 15 hours.[47][48][49]

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy (HBOT) increases the deformability of red blood cells, decreases oedema formation in ischaemic tissues, and has some bacteriostatic effects. Its efficacy in frostbite depends on the extent of thrombosis of the microvasculature.[14] Anecdotal cases of frostbite patients treated with HBOT have demonstrated promising results.[50][51] Early wound demarcation and tissue preservation was reported in 2 patients who received delayed (28 days post-injury) HBOT for severe frostbite injuries.[52]

Pentoxifylline

Pentoxifylline increases red blood cell flexibility, thereby aiding revascularisation. There are anecdotal reports of benefit in humans.[53][54][55]

Botulinum toxin

In one case study, botulinum toxin type A injections improved skin perfusion, cold hypersensitivity, and pain in a patient with frostbite sequelae.[56] Post-procedure angiography showed improved dilation of the digital arteries compared with studies performed before botulinum toxin injection.

Wound dressings

A reduced number of dressing changes may decrease pain, and increase patient satisfaction with the use of hydrofiber silver dressings (typically used for thermal burns) in frostbite patients.[16] Similar results in frostbite studies have been reported with an alloplastic skin substitute also used in the management of thermal burns.[57] Better results were observed when the dressing was applied within 24 hours of injury. Substantial oedema post-rewarming should be anticipated, and circumferential dressings should be wrapped loosely to allow for the swelling, without placing pressure on the underlying tissue.[33]

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