Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2023; 11(34): 8219-8227
Published online Dec 6, 2023. doi: 10.12998/wjcc.v11.i34.8219
Comprehensive treatment of deep frostbite of multiple fingers after trauma: A case report
Xi-Hua Wang, Min Li, Yue Cheng, Guang-Jian Wang, Guo-Le Lin, Wei-Nan Liu
Xi-Hua Wang, Min Li, Guang-Jian Wang, Guo-Le Lin, Wei-Nan Liu, Department of General Surgery, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing 100730, China
Yue Cheng, Department of Nursing, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing 100730, China
Co-first authors: Xi-Hua Wang and Min Li.
Co-corresponding authors: Guo-Le Lin and Wei-Nan Liu.
Author contributions: Wang XH supported the management of this case, collated information for and drafted this report, and managed manuscript revisions; Li M and Cheng Y supported the management of this case and collated information for and drafted this report; Wang XH, Li M, and Cheng Y contributed equally to this work; Lin GL and Liu WN supported in the management of this case and were responsible for revising the manuscript; Wang GJ supported the management of this case; all authors issued final approval for the submission of the manuscript; Wang XH supported the management of this case (was in charge of the care of this case), collated information for and drafted this report, and managed manuscript revisions (revised the manuscript); Li M supported the management of this case (was also in charge of the patient) and collated information for and drafted this report; Wang XH and Li M contributed equally to this work. Wang XH and Li M work together in the same department for a long time. Li M is the leader of this department. They had a graduate advisor in common. Wang XH and Li M are both enterostomal therapists, dedicated to the treatment of wounds and ostomies. In this case, Wang XH and Li M worked together to review the data, and develop and validate treatment plans. They followed this case for 6 mo. Both of them drafted this report. Lin GL is the chief physician and the primary person in charge of the treatment of this case, providing medical guidance and oversight. Liu WN is the deputy chief nurse, an expert in surgical nursing, and the leader of the surgical nursing team, giving guidance and oversight on the nursing plan. In the treatment process of this case, we tried new treatment methods. Lin GL and Liu WN gave us help in the feasibility and effectiveness of the treatment process. They were jointly responsible for the review and revision of this article and the whole process of submission. Lin GL and Liu WN contributed equally to this work.
Supported by National High Level Hospital Clinical Research Funding, No. 2022-PUMCH-C-005.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Le Lin, MD, PhD, Chief Physician, Doctor, Professor, Department of General Surgery, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Road, Dongcheng District, Beijing 100730, China. linguole@126.com
Received: October 6, 2023
Peer-review started: October 6, 2023
First decision: October 17, 2023
Revised: October 27, 2023
Accepted: November 29, 2023
Article in press: November 29, 2023
Published online: December 6, 2023
Abstract
BACKGROUND

Frostbite is becoming increasingly common in urban environments, and severe cases can lead to tissue loss. The treatment goal is to preserve tissue and function; the sooner appropriate treatment is administered, the more tissue can be saved. However, not every patient with deep frostbite seeks medical care promptly.

CASE SUMMARY

We report the case of a 73-year-old male patient who was lost in the wilderness for 2 d due to trauma and confusion. He experienced deep frostbite on multiple fingers. Treatment should not be discontinued for patients with deep frostbite who present after the optimum treatment timing. Bullae that no longer form (bloody) blisters within 24 h of aspiration should be removed. Mucopolysaccharide polysulfate cream has clinical value in frostbite treatment. The patient was transferred to Chinese Academy of Medical Sciences and Peking Union Medical College Hospital 12 h after being rescued. The patient had contraindications for thrombolysis, the most effective treatment, due to intracranial hemorrhage and presenting past the optimum treatment timing. We devised a comprehensive treatment plan, which involved delayed use vasodilators and high-pressure oxygen therapy at day 49 post-injury. We experimented with mucopolysaccharide polysulfate cream to treat the frostbite. The aim of the treatment was to safeguard as much tissue as possible. In the end, the fingers that suffered from frostbite were able to be partially preserved.

CONCLUSION

The case indicated that patients with severe frostbite who missed the optimal treatment time and had contraindications for thrombolysis could still partially preserve the affected limbs through comprehensive treatment.

Keywords: Frostbite, Wound care, Mucopolysaccharide polysulfate cream, Case report

Core Tip: Frostbite, increasingly common in urban areas, requires swift treatment for tissue preservation. Not all deep frostbite cases receive prompt medical attention. A 73-year-old male, lost in the wilderness for 2 d post-trauma, presented with deep frostbite on multiple fingers. Despite a 12-h delay, he received comprehensive, delayed treatment at the Chinese Academy of Medical Sciences and Peking Union Medical College Hospital. Contraindications for thrombolysis led to an alternative plan, including extended vasodilator use and high-pressure oxygen therapy from day 49 post-injury. This case emphasizes the vital importance of timely frostbite treatment and offers insights into managing delayed cases with contraindications.