title: Frostbite of both first digits of the foot treated with delayed hyperbaric oxygen:a case report and review of literature.
abstract: BACKGROUND
  Frostbite is an uncommon event that can occur from exposure to temperatures below -4 degrees C and can lead to potential serious tissue damage and necrosis. This in turn can result in debilitating amputations in otherwise healthy people. The pathophysiological mechanisms of frostbite have marked similarities to those seen in thermal burns, ischemia/reperfusion injuries and crush injuries--i.e., non-healing wounds and inflammatory processes. These injuries are commonly treated with hyperbaric oxygen therapy.
  
  
  OBJECTIVE
  Evidence for treating frostbite with hyperbaric oxygen (HBO2) is scarce, and to date HBO2 is not a standard addition in the multidisciplinary care of freezing injuries. We aim to contribute to the available evidence with a case report and review the literature to reassess the multidisciplinary treatment of frostbite injuries.
  We present a case report of a woman with deep frostbite of the toes treated with hyperbaric oxygen therapy, after a delay of 21 days, with good results. No surgical intervention was needed. A literature search revealed 17 human case reports on frostbite and four animal studies in which hyperbaric oxygen was applied. All case reports showed positive effects, and in none of the cases was amputation necessary. In the animal studies, two showed significant positive results regarding tissue loss and reduction of inflammatory markers, whereas two did not.
  
  
  CONCLUSIONS
  Based on our case report as well as the literature and the mechanisms of hyperbaric oxygen, we make the recommendation that this therapy be considered as an addition to the multidisciplinary treatment of frostbite, even after significant delay of treatment.
authors.forename: Tom C P M
authors.initials: TC
authors.lastname: Kemper
authors.forename: Vincent M
authors.initials: VM
authors.lastname: de Jong
authors.forename: Helen A
authors.initials: HA
authors.lastname: Anema
authors.forename: Albert
authors.initials: A
authors.lastname: van den Brink
authors.forename: Robert A
authors.initials: RA
authors.lastname: van Hulst
mesh_terms: D005260:Female; D005627:Frostbite / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D009051:Mountaineering / Q000293:injuries*; D009390:Nepal; D013997:Time Factors; D014034:Toes / Q000293:injuries*