A case of severe frostbite on Mt Blanc: a multi-technique approach

Abstract

Frostbite is generally regarded as a peculiar environment-induced pathological condition from cold climates, which can become a particularly major health hazard during cold warfare. However, there can also be increased prevalences regularly in temperate climatic zones due to microclimatic cold periods [1]. A subject group especially prone to cold injuries is mountain climbers, the growing subpopulation of people climbing high mountains in harsh environmental conditions. In the Chamonix Hospital, over 1300 cases were seen between 1974 and 1992 [2, unpublished observations]. The prevalence of frostbite among climbers depends on many factors like the season, latitude, altitude, weather and, last but not least, clothing and behavior of the climber [2]. Once frostbite has developed, morbidity depends greatly on the therapeutic measures taken. This fact has long been understood and the principles of treatment have changed little recently. Waiting for a clear demarcation line before amputation is still valid. To this precept, additional therapeutic recommendations have been added, among them antibiotics, hemodilution, anti-clotting drugs and anti-thromboxane Az [3]. Recent advances in technology have created possibilities to understand better the pathophysiology underlying frostbite. Some techniques, like osseous scintigraphy, are used to predict the severity of the injury before demarcation becomes evident [3-7]. This paper reports a particularly severe case of deep symmetrical frostbite of the feet. At different stages of the illness, several modern techniques were used to investigate various parameters in this patient. To our knowledge, this is the first case of severe frostbite in which 31p nuclear magnetic resonance spectroscopy elp-NMRS) and muscle ultrastructure were studied. The purpose of this paper is to discuss briefly the pathophysiology of frostbite, illustrated by the results obtained from the different investigations in this patient.