Next Steps - Follow-up
Symptoms follow a predictable pathway. Numbness initially is followed by a throbbing sensation that begins with rewarming and may last weeks to months. This is then typically replaced by a lingering feeling of tingling with occasional electric-shock sensations. Cold sensitivity, sensory loss, chronic pain, and a variety of other symptoms may last for years.
The treatment of frostbite is done over a period of weeks to months. Definitive therapy, possibly in the form of surgery, may not be performed for up to 6 months after the initial injury. Therefore, establish a working relationship between you and your doctor that will continue throughout the healing process.
The first step in preventing frostbite is knowing whether you are at increased risk for the injury.
- Most cases of frostbite are seen in alcoholics, people with psychiatric illness, car accidents or car breakdowns in bad weather, and recreational drug misuse.
- All of these conditions share the problem of cold exposure and either the unwillingness or inability of a person to remove himself or herself from this threat.
- Tobacco smokers and people with diseases of the blood vessels also are at increased risk because they have an already decreased amount of blood flow to their arms and legs.
- Homelessness, fatigue, dehydration, improper clothing, and high altitude are additional risk factors.
Although people don't always know or acknowledge these dangers, many of the dangers can be reduced or prevented.
- Dress for the weather.
- Layers are best, and mittens are better than gloves (keeps your warm fingers together while warming each other).
- Wear 2 pairs of socks, with the inner layer made of synthetic fiber, such as polypropylene, to wick water away from the skin and the outer layer made of wool for increased insulation.
- Shoes should be waterproof.
- Cover your head, face, nose, and ears at all times.
- Clothes should fit loosely to avoid a decrease in blood flow to the arms and legs.
- Always travel with a friend in case help is needed.
- Avoid smoking and alcohol.
People with diabetes and anyone with vessel disease should take extra precautions, as should the very young, very old, and unconditioned.
Be especially wary of wet and windy conditions. The "feels like" temperature (windchill) is actually much lower than the stated air temperature.
A common saying among surgeons who have treated people with frostbite is "frostbite in January, amputate in July." It often takes months before the final separation between healthy and dead tissue may be determined. If surgery is performed too early, the risks of removing tissue that may eventually recover or leaving behind tissue that may eventually die are great. Some radiographic techniques currently are being investigated that may be able to make this division much sooner, thus permitting earlier definitive treatment. In some cases, bone scans are used to help predict the viability of tissue.
Beyond this waiting period, 65% of people will suffer long-term symptoms because of their frostbite. Common symptoms include pain or abnormal sensations in the extremity, heat or cold sensitivity, excessive sweating, and arthritis.