Digital Frostbite
A 42-year-old man presented for outpatient follow-up 6 days after being released from the hospital, where he had been admitted 9 days earlier for digital frostbite, hypothermia, and rhabdomyolysis. Before admission, he had gone on a winter hike alone and was caught in an unexpected snowstorm that obscured visibility. He became disoriented, lost sight of the trail, and fell into icy water, after which his hands became frozen in his gloves. After 36 hours of outdoor exposure to freezing conditions, he was rescued and admitted to the local hospital, where he was treated with a hyperthermic bath, warm intravenous fluids, topical silver sulfadiazine, and physical therapy and was discharged home after 3 days. At follow-up, examination of his hands revealed edema, purple discoloration, and sloughing of the skin on all digits except his left thumb (Panel A). Serial débridements were performed and stellate ganglion blocks were administered on an outpatient basis. The appearance of his fingers and right thumb improved over the next month (Panel B). Demarcation of necrotic, mummified tissue on the distal left ring finger and right middle and ring fingers was noted 2 months after the initial injury (Panel C). Amputation of the affected areas was subsequently performed; intraoperative findings included nonbleeding, necrotic bone (Panel D). Postoperative healing was uneventful (Panel E).
