title: The emerging role of tissue plasminogen activator in the management of severe frostbite.
abstract: This article presents a small case series demonstrating clinical success with thrombolytic agents for severe frostbite injury to the lower extremities. The authors report three patients with severe frostbite injuries to their distal lower extremities who were managed with urgent interventional radiology and intra-arterial tissue plasminogen activator infusion according to a prespecified protocol. Limbs and digits were successfully salvaged and patients returned to normal activity within 2 weeks. Although further studies are needed, results of this study support a new approach in the management of frostbite: from conservative management and observation to urgent interventional radiology and possible tissue plasminogen activator infusion. A protocol for the management of such injuries is presented.
authors: From the *Division of Burns, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston; †Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland; ‡UNECOM/Kent Hospital Emergency Medicine Program, Warwick, Rhode Island; and §Department of Radiology, Massachusetts General Hospital, Boston.
authors: Amir E
authors: AE
authors: Ibrahim
authors: Jeremy
authors: J
authors: Goverman
authors: Karim A
authors: KA
authors: Sarhane
authors: Jill
authors: J
authors: Donofrio
authors: T Gregory
authors: TG
authors: Walker
authors: Shawn P
authors: SP
authors: Fagan
mesh_terms: D000328:Adult; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005385:Fingers / Q000098:blood supply / Q000000981:diagnostic imaging*; D005627:Frostbite / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014034:Toes / Q000098:blood supply / Q000000981:diagnostic imaging*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator