What is the role of rewarming in the treatment of frostbite?

Updated: Oct 13, 2020
  • Author: Bobak Zonnoor , MD; Chief Editor: Dirk M Elston, MD  more...
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Rapid rewarming is the single most effective therapy for frostbite. [45] Variations on the original work of McCauley et al are used at most centers experienced in the management of the frostbite patient. [29] This includes admission of all frostbite patients to a specialty unit, if possible. Consider obtaining photographic records on admission, at 24 hours, and serially every 2-3 days until discharge.

On admission, rapidly rewarm the affected area in circulating water (ie, a whirlpool bath) at 37-39°C. The circulation of water allows a constant temperature to be applied to the affected area. Warming is continued for 15-30 minutes or until thawing is, by clinical assessment, complete (ie, when the distal area of the extremity is flushed, soft, and pliable). The addition of an antiseptic solution such as povidone-iodine or chlorhexidine to the bath may be beneficial.

Avoid inadvertent slow rewarming or overheating. Encourage active gentle motion of the frostbitten area during the rewarming. Constantly monitor water temperature. Thawing takes about 20-40 minutes for superficial injuries and as long as 1 hour for deep injuries.

The most common error in this stage of treatment is premature termination of the rewarming process because of reperfusion pain. Mechanical trauma (massaging or rubbing with ice or by hand) and rewarming at higher temperatures and for longer periods of time are detrimental to preserving viable tissue and should be avoided. Direct dry heating using fire or a heater can lead to burns secondary to loss of temperature sensation and so should be avoided.

Partial thawing and refreezing generate more damage than does prolonged freezing alone, through the release of multiple inflammatory mediators. In patients who experience a refreezing injury of thawed areas, rewarming should be delayed until it can be maintained.

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