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ABSTRACT
Frostbite sequelae are a relevant occupational injury outcome for soldiers in arctic environments. A Caucasian male soldier suffered frostbite to both hands during a military winter exercise. He developed sensory-motor disturbances and cold hypersensitivity. Angiography and thermography revealed impaired blood flow while Quantitative Sensory Testing indicated impaired somato-sensory nerve function. Two years after the initial event, he received an off label treatment with Botulinum toxin distributed around the neurovascular bundles of each finger. After treatment, cold sensitivity was reduced while blood flow and somato-sensory nerve function improved. The successful treatment enabled the soldier to successfully pursue his career in the army.
ARTICLE HISTORY
Received 8 November 2016
Revised 9 December 2016
Accepted 12 December 2016
KEYWORDS
Frostbite; cold injury; botulinum toxin; vasospastic disorder; thermography; non-freezing cold injury; quantitative sensory testing; angiography; military; army
Introduction
Frostbite has for decades, been a relevant problem in the military, and continue to be so. In recent years, cold injuries have also become more prevalent within the civilian population due to increasing interest in extreme outdoor recreation activities. The increasing number of homeless people after the recent financial crisis constitutes another growing group of particularly vulnerable individuals [1]. At the same time, sufficient standard medical treatment is currently lacking [2].
Frostbite has been defined as injury to body tissues caused by exposure to extreme cold, typically affecting the extremities and often involving only the skin, which initially becomes white and hard, but in severe cases resulting in gangrene of deeper tissues and loss of the affected parts [3]. The pathophysiological process is caused by heat loss sufficient to cause ice crystal formation in superficial or deep tissue [1]. During the last two decades, newer therapies aimed at prevention of extensive tissue injuries have shown promising results in experimental studies and case reports [1,4,5]. In addition to the acute injury, frostbite is often associated with long-term sequelae [6]. These sequelae are less well studied and treatment is often difficult.
Depending on the type of cold injury, cold hypersensitivity, sensory loss, chronic pain, hyperhidrosis, growth plate disturbances and osteoarthritis may develop [7]. Long-term paraesthesia with occasional electric shock-type sensations have also been reported [8,9]. These sequelae may have a considerable negative impact on the quality of life.
For the military,...