“COLD INJURY” IN A TEMPERATE CLIMATE REPORT OF THREE RECENT CASES WITH A REVIEW OF THE LITERATURE

Three recent cases of cold Injury treated at Prince Henry Hospital are presented. These three cases demonstrate some of the classical features of “frostbite”, including a pre-inflammatory stage, an acute inflammatory phase, and a post-inflammatory phase with ultimate demarcation of gangrene at a more distal level than first expected. Some later sequelae, which include increased cold sensitivity and hyperæsthesia, were also seen. Aspects of treatment are considered, and the varying policies that have been recommended are discussed. Review of experimental and clinical data leads to the conclusion that there are many gaps In our knowledge of the precise pathogenesis of cold injury. Rapid rewarming with supportive therapy is advocated for immediate management, amputation of necrotic tissue being delayed until maximal recovery has occurred. Sympathectomy is probably of value only in cases of later cold hypersensitivity.