FROSTBITE IN GANGRENE

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 SurgicalDepartment, of Combined Military Hospital Gilgit from January 2002 to February 2005. Material and methods: All thepatients who reported to the hospital with frost bite were admitted and enrolled in the study. The local examination ofwound was done and all the physical signs were recorded. The frost bite was labeled according to the severity from 1stto 4th degree in accordance to the specified criteria. All the patients were placed on a standard treatment protocolcomprising of injection of Benzyl Penicillin 10 lac U x 6 hourly, injection of Heparin 5000 IU s/c x 6 hourly and tabletsIbuprofen 400mg x 8 hourly for 5-7 days. The condition of wound was assessed daily till 8 weeks after admission. Theend point of medical treatment was a clear demarcation of dry gangrenous and viable tissue, or the formation of moistgangrene or infection in frost bitten area which was spreading proximally. Once this condition was reached the patientswere planned for amputation surgery. Results: Total numbers of patients included were 96. Among them 33 had 1stdegree, 37 had 2nd degree, 16 had 3rd degree and 10 had 4th degree frost bite. All the 33 patients of 1st degree frost biterecovered well and were discharged from the hospital without any surgical intervention. 16 patients among the total 37who sustained 2nd degree frost bite developed superficial ulcers over the skin. These patients required regular wounddressings and recovered well by 6 weeks of treatment without any limb loss. 7 out of total 16 patients of 3rd degree andall the 10 patients of 4th degree frost bite developed gangrenes. They were observed till 8 weeks and after that theyunderwent amputations. Conclusion: In accordance to the results it is concluded that most of the patients who had3rd degree of frostbite and all the patients who sustained 4th degree frost bite developed gangrene by 8 weeks ofhospitalization despite of the treatment. None of the patient of 1st and 2nd degree frostbite developed gangrene. Hencethe initial assessment of a patient was very useful in predicting the chances of development of gangrene.