Successful Treatment of Frostbite Lesions in Arctic Greenland

Frostbite may cause severe tissue damage and lead to tissue loss and limb amputations. Frostbite lesions occur in skin exposed to temperatures below zero degrees Celsius for a prolonged period of time. During frostbite, ice crystals are formed in affected tissue. After reheating of the affected areas, varying degrees of reperfusion injury and inflammation occur. This reperfusion injury and inflammation is mediated by prostaglandines [1,2]. Frostbite is classified in four stages [2]. First degree frostbite lesions present as white plaques with reduced sensitivity, erythema, and possibly mild edema. Second degree frostbite lesions are characterized by erythema, edema and bullae containing clear fluid. In third degree frostbite lesions, tissue destruction compromises the dermal layer. Third degree frostbite lesions are characterized by blood-filled small bullae, skin necrosis and blue-gray discoloration of the skin. Fourth degree frostbite lesions affect muscles and bones. These fourth degree lesions can present with edema, red or cyanotic skin that can later become dry and black [3]. Third and fourth degree frostbite may results in tissue necrosis and tissue loss. In addition, frostbite can cause long-term complications like chronic pain, neuropathy, hypersensitivity to cold and decreased sensitivity [3]. Risk factors for frostbite lesions include low temperatures, high wind chill factor, smoking and alcohol, as well as medical conditions such as diabetes, neuropathy, dementia and psychiatric disorders [2-4]. Most often, fingers, toes, cheeks, nose and ears are affected [3-6]. The occurrence of frostbite is increasing due to increased travel activity to arctic areas and mountain areas at high altitude. In Greenland, a large part of the population are hunters and fishermen and are therefore at risk of developing frostbite [6]