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Kevin J. Bruen, MD; James R. Ballard, BS; Stephen E. Morris, MD; Amalia Cochran, MD; Linda S. Edelman, MPhil, BSN; Jeffrey R. Saffle, MD

Arch Surg. 2007;142:546-553.

Hypothesis  Thrombolytic therapy will decrease the incidence of amputation when administered within 24 hours of exposure.

Design  Single institution retrospective review of clinical outcomes and resource use.

Setting  Burn unit of a tertiary academic referral center.

Patients  From 2001 to 2006, patients with severe frostbite admitted within 48 hours of injury underwent digital angiography and treatment with intra-arterial tissue plasminogen activator (tPA) if abnormal perfusion was demonstrated. These patients were compared with those treated from 1995 to 2006 who did not receive tPA.

Interventions  Tissue plasminogen activator vs traditional management of frostbite injury.

Main Outcome Measures  Number and type of surgery were recorded, along with amputations of digits (fingers or toes) and more proximal (ray, transmetatarsal, or below-knee) amputations. Resource utilization including length of stay, total costs, cost per involved digit, and cost per saved digit were analyzed.

Results  Thirty-two patients with digital involvement (hands, 19%; feet, 62%; both, 19%) were identified. Seven patients received tPA, 6 within 24 hours of injury. The incidence of digital amputation in patients who did not receive tPA was 41%. In those patients who received tPA within 24 hours of injury, the incidence of amputation was reduced to 10% (P<.05).

Conclusions  Tissue plasminogen activator improved tissue perfusion and reduced amputations when administered within 24 hours of injury. This modality represents the first clinically significant advancement in the treatment of frostbite in more than 25 years.

Author Affiliations: Division of General Surgery (Drs Bruen, Morris, Cochran, and Saffle, and Mr Ballard and Ms Edelman), and the Burn Center (Drs Morris, Cochran, and Saffle, and Ms Edelman), University of Utah, Salt Lake City.

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