Fourth-degree frostbite complicated by necrotizing fasciitis in an indigenous Mexican patient: bilateral below-knee amputation and ethical challenges in tissue salvage a case report

Q3 Medicine
Norman Alejandro Rendon Mejia , Luisa Fernanda Cuervo Ollervides , Laura Elizabeth Piñon Gaytan , Jose Francisco De la Torre Ramos , Alejandra Aguirre Aguilar , Carlos Alan Benitez Membrila
{"title":"Fourth-degree frostbite complicated by necrotizing fasciitis in an indigenous Mexican patient: bilateral below-knee amputation and ethical challenges in tissue salvage a case report","authors":"Norman Alejandro Rendon Mejia ,&nbsp;Luisa Fernanda Cuervo Ollervides ,&nbsp;Laura Elizabeth Piñon Gaytan ,&nbsp;Jose Francisco De la Torre Ramos ,&nbsp;Alejandra Aguirre Aguilar ,&nbsp;Carlos Alan Benitez Membrila","doi":"10.1016/j.burnso.2025.100414","DOIUrl":null,"url":null,"abstract":"<div><div>Frostbite, a debilitating injury caused by freezing temperatures, disproportionately affects marginalized populations, yet data from non-circumpolar regions remain critically underrepresented. We present the first documented case in Mexico of severe frostbite requiring bilateral below-knee amputation in a 26-year-old Indigenous man discovered unconscious with alcohol intoxication in subfreezing conditions. Clinical assessment revealed fourth-degree frostbite manifesting as dry necrosis, absent distal pulses, and purulent vesicles. Computed tomography angiography demonstrated popliteal artery occlusion and subfascial gas, confirming concurrent necrotizing fasciitis. Emergency bilateral amputation with fasciocutaneous flap reconstruction resulted in an uncomplicated recovery, enabling discharge on postoperative day 6 for multidisciplinary rehabilitation. This case underscores the ethical complexity of prioritizing limb salvage versus infection mitigation in resource-limited settings and advocates for context-specific, dynamic frostbite management guidelines. Furthermore, frostbite emerges as a sentinel of systemic inequity, reflecting social determinants such as inadequate access to cold-weather protection, alcohol misuse, and healthcare disparities. Culturally tailored prevention strategies—including multilingual community education and equitable healthcare infrastructure—are imperative. As climate change intensifies extreme weather events, frostbite management must evolve beyond acute interventions to address structural vulnerabilities, integrating public health and policy reforms.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"11 ","pages":"Article 100414"},"PeriodicalIF":0.0000,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Burns open : an international open access journal for burn injuries","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468912225000227","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

Abstract

Frostbite, a debilitating injury caused by freezing temperatures, disproportionately affects marginalized populations, yet data from non-circumpolar regions remain critically underrepresented. We present the first documented case in Mexico of severe frostbite requiring bilateral below-knee amputation in a 26-year-old Indigenous man discovered unconscious with alcohol intoxication in subfreezing conditions. Clinical assessment revealed fourth-degree frostbite manifesting as dry necrosis, absent distal pulses, and purulent vesicles. Computed tomography angiography demonstrated popliteal artery occlusion and subfascial gas, confirming concurrent necrotizing fasciitis. Emergency bilateral amputation with fasciocutaneous flap reconstruction resulted in an uncomplicated recovery, enabling discharge on postoperative day 6 for multidisciplinary rehabilitation. This case underscores the ethical complexity of prioritizing limb salvage versus infection mitigation in resource-limited settings and advocates for context-specific, dynamic frostbite management guidelines. Furthermore, frostbite emerges as a sentinel of systemic inequity, reflecting social determinants such as inadequate access to cold-weather protection, alcohol misuse, and healthcare disparities. Culturally tailored prevention strategies—including multilingual community education and equitable healthcare infrastructure—are imperative. As climate change intensifies extreme weather events, frostbite management must evolve beyond acute interventions to address structural vulnerabilities, integrating public health and policy reforms.
四度冻伤合并坏死性筋膜炎的墨西哥土著患者:双侧膝下截肢和组织抢救的伦理挑战的病例报告
冻伤是由低温造成的一种使人衰弱的伤害,对边缘人群的影响尤为严重,但来自非极地地区的数据仍然严重不足。我们报告了墨西哥第一例严重冻伤需要双侧膝盖以下截肢的26岁土著男子,在低于冰点的条件下发现酒精中毒而失去知觉。临床评估显示四度冻伤表现为干性坏死,远端脉搏缺失,化脓性囊泡。计算机断层血管造影显示腘动脉闭塞和筋膜下气体,证实并发坏死性筋膜炎。紧急双侧截肢与筋膜皮瓣重建导致简单的恢复,使出院术后第6天进行多学科康复。该病例强调了在资源有限的情况下,优先考虑肢体保留与减轻感染的伦理复杂性,并倡导制定针对具体情况的动态冻伤管理指南。此外,冻伤是系统性不平等的哨兵,反映了诸如无法充分获得寒冷天气保护、滥用酒精和医疗保健差距等社会决定因素。有文化针对性的预防战略——包括多语言社区教育和公平的卫生保健基础设施——势在必行。随着气候变化加剧极端天气事件,冻伤管理必须超越急性干预措施,解决结构性脆弱性,将公共卫生和政策改革结合起来。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
1.20
自引率
0.00%
发文量
0
审稿时长
15 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信