Management of the frostbitten hand.

Twenty cases of moderate and severe frostbite of the hands were analysed to establish trends in surgical treatment. Excision of large blisters and early mobilization in flamazine bags were found to be beneficial. In those patients whose initial skin changes did not extend to the base of the fingers only minor amputations were necessary. The small amounts of necrotic tissue did not interfere with hand movement and operation was therefore delayed until six or seven weeks, so that maximal digital length could be preserved. In contrast, those patients whose initial skin changes involved the whole length of the fingers or extended on to the hands, more proximal amputations were necessary and these amputations were performed at three to four weeks in order to remove the larger amounts of necrotic tissue and facilitate early mobilisation.