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 Release 22.0, Sept. 2008
 
The Medical Algorithms Project
Chapter : ch34. Environmental Health Section : Low Environmental Temperatures
  Algorithm of Greenwald et al for Management of Frostbite Involving the Hands or Feet

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Copyright (c) 2008-2010, Institute for Algorithmic Medicine, Houston, TX, USA. All rights reserved.

Overview :

Greenwald et al developed an algorithm for the management of frostbite involving the fingers or toes. This can help triage patients to different treatment regimens and can identify those who may benefit from early and aggressive therapy. The authors are from Tampa General Hospital (Florida!) and the University of Chicago.

 

Parameters:

(1) depth of injury based on clinical evaluation

(2) ability to salvage based on triple phase scan

(3) triple phase scan (TPS) pattern (based on intravascular injection of a radioactive isotope and interval tracking)

 

Depth

Salvagability

TPS Pattern

Management

superficial

NA

NA

1 and 2

deep

No

NA

3

deep

Yes

normal blood pool and bone pool

1 and 2

deep

Yes

little or no blood pool; decreased but visible bone pool

1 and 2

deep

Yes

little or no blood pool; little or no bone pool

4

 

Management options:

(1) Aspiration of blisters.

(2) Observation with delayed debridement if necessary.

(3) Amputation.

(4) Aggressive early debridement with salvage surgery and flap transfer.

 

  References:

Greenwald D, Cooper B, Gottlieb L. An algorithm for early aggressive treatment of frostbite with limb salvage directed by triple-phase scanning. Plast Reconstr Surg. 1998; 102: 1069-1074.

Mehta RC, Wilson MA. Prediction of tissue viability with triple-phase bone scanning. Radiology. 1989; 170: 511.

 

 
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