Clinical Presentation and Management of Frostbite

Pathophysiology and Mechanism

The fundamental mechanism of tissue damage involves formation of ice crystals within cells that destroy cell membrane integrity, causing both immediate cellular death and progressive inflammatory processes with tissue ischemia, according to the American Heart Association 2, 3

A characteristic hallmark of acute frostbite is the complete inability to sense touch, including ongoing mechanical tissue damage, as noted by the American College of Cardiology 1, 4
Patients with frostbitten hands or feet may be unaware of damage caused by continued movement or walking, as reported by the American Heart Association 3, 5
Skin color progresses from pale to hardened and dark as severity increases, according to the American College of Cardiology 1, 4

The extremities are particularly susceptible: fingers, toes, nose, and ears are most commonly affected, as noted by the American College of Cardiology 1, 4

In extreme cases, deep frostbite can cause tissue necrosis leading to digit or limb loss, as reported by the American Heart Association 1, 5

Estimating the size and severity of frostbitten tissue is challenging, especially in the first aid setting, according to the American College of Cardiology 1, 4

Frostbite is a common finding in hypothermic individuals, requiring prioritization of core rewarming before extremity treatment, as noted by the American Heart Association 1, 4
Rewarming extremities first in hypothermic patients can cause core temperature to decrease, as reported by the American College of Cardiology 3, 5

Frozen and thawed tissues are extremely vulnerable to further injury and infection, according to the American Heart Association 1, 3
Tissues become susceptible to pressure sores and necrosis after thawing, as noted by the American College of Cardiology 4, 5