Woo Eun-Kyung, Lee Jong Wook, Hur Gi-Yeun, Koh Jang-Hyu, Seo Dong-Kook, Choi Jai-Ku, Jang Young-Chul
Department of Plastic and Reconstructive Surgery, Hallym University Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Arch Plast Surg. 2013 Sep;40(5):510-6. doi: 10.5999/aps.2013.40.5.510. Epub 2013 Sep 13.
This paper discusses the treatment protocol for patients with frostbite.
We performed a retrospective analysis of a series of 17 patients with second- and higher-degree frostbite who had been treated at our medical institution between 2010 and 2012.
Our clinical series of patients (n=17) included 13 men and four women, whose mean age was 42.4±11.6 years (range, 22-67 years). The sites of injury include the foot in six patients (35.3%), the hand in six patients (35.3%) and the facial region in five patients (29.4%). Seven patients with second-degree frostbite were completely cured with only conservative treatment during a mean period of 12.7±3.3 days (range, 8-16 days). Of the five patients with third-degree frostbite, two underwent skin grafting following debridement, and the remaining three achieved a complete cure with conservative treatment during a mean period of 35±4.3 days (range, 29-39 days). Five patients with fourth-degree frostbite were treated with surgical procedures including amputation.
With the appropriate conservative management in the early stage of onset, surgeons should decide on surgery after waiting for a sufficient period of time until the demarcation of the wound. Continuous management of patients is also needed to achieve functional recovery after a complete cure has been achieved. This should also be accompanied by patient education for the avoidance of re-exposure to cold environments.
本文讨论冻伤患者的治疗方案。
我们对2010年至2012年在我院接受治疗的17例二度及以上冻伤患者进行了回顾性分析。
我们的临床系列患者(n = 17)包括13名男性和4名女性,平均年龄为42.4±11.6岁(范围22 - 67岁)。损伤部位包括足部6例(35.3%)、手部6例(35.3%)和面部5例(29.4%)。7例二度冻伤患者仅通过保守治疗在平均12.7±3.3天(范围8 - 16天)内完全治愈。5例三度冻伤患者中,2例在清创后接受了皮肤移植,其余3例通过保守治疗在平均35±4.3天(范围29 - 39天)内完全治愈。5例四度冻伤患者接受了包括截肢在内的外科手术治疗。
在发病早期进行适当的保守治疗,外科医生应等待足够长的时间直至伤口分界后再决定是否进行手术。在完全治愈后,还需要对患者进行持续管理以实现功能恢复。这还应伴随着对患者进行教育,以避免再次暴露于寒冷环境。