Frostbite in Oxfordshire: the impact of a severe winter on an unprepared civilian population.

The winter of 1981-1982 in Oxfordshire was unusually cold. During this winter, 18 patients with frostbite were referred to the Peripheral Vascular Service of the Nuffield Department of Surgery. The age-range was 52-83 years. None was diabetic. Seven were smokers. All had frostbite of either feet or fingers, sometimes of both. Patients could be divided into 2 groups based on the severity of their injury. In the first group 10 patients had mild injuries and were managed as outpatients. One patient had terminal phalanges amputated as a day case. Patients in this group had adequate homes and no associated medical disease. Eight patients in the second group had severe frostbite. All were socially disadvantaged and 4 had significant medical disease (mitral valve disease, lymphoma, alcoholism and depression). Because of social circumstances and because it takes time to establish the line of demarcation between healthy and dead tissue, all patients in this group were in hospital for a minimum of 2 months (range 2-10 months). Four patients required skin grafting and 2 needed special shoes to enable them to walk. There needs to be greater public awareness of the dangers and risks of cold injury.