Frostbite of both irst digits of the foot treated with delayed hyperbaric oxygen: A case report and review of literature Tom C.P.M. Kemper M.Sc. 1 , Vincent M. de Jong M.D. 2 , Helen A. Anema Ph.D. 3 , Albert van den Brink M.D. 1 , Robert A. van Hulst M.D. Ph.D. 1,4 1 Department of Hyperbaric Medicine and Laboratory Experimental Intensive Care Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands 2 Department of Trauma Surgery, Academic Medical Center, Amsterdam, The Netherlands 3 Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands 4 Diving Medical Center, Royal Netherlands Navy, Den Helder, The Netherlands CORRESPONDING AUTHOR: Tom C.P.M. Kemper – t.kemper@icloud.com UHM 2014, VOL. 41, NO. 1 – HBO 2 fOR THE TREATMENT Of fROSTBITE ______________________________________________________________________________________________ ABSTRACT Background: Frostbite is an uncommon event that can occur from exposure to temperatures below -4°C and can lead to potential serious tissue damage and necrosis. This in turn can result in debilitating amputations in otherwise healthy people. The patho- physiological mechanisms of frostbite have marked similarities to those seen in thermal burns, ischemia/ reperfusion injuries and crush injuries — i.e., non- healing wounds and inlammatory processes. These injuries are commonly treated with hyperbaric oxygen therapy. Objectives: Evidence for treating frostbite with hyper- baric oxygen (HBO 2 ) is scarce, and to date HBO 2 is not a standard addition in the multidisciplinary care of freezing injuries. We aim to contribute to the available evidence with a case report and review the literature to reassess the multidisciplinary treatment of frostbite injuries. Case report and review of literature: We present a case report of a woman with deep frostbite of the toes treated with hyperbaric oxygen therapy, after a delay of 21 days, with good results. No surgical intervention was needed. A literature search revealed 17 human case reports on frostbite and four animal studies in which hyperbaric oxygen was applied. All case reports showed positive effects, and in none of the cases was amputation necessary. In the animal studies, two showed signiicant positive results regarding tissue loss and reduction of inlammatory markers, whereas two did not. Conclusions: Based on our case report as well as the literature and the mechanisms of hyperbaric oxygen, we make the recommendation that this therapy be considered as an addition to the multi- disciplinary treatment of frostbite, even after signi- icant delay of treatment. _____________________________________________________________________________________________ 65 Copyright © 2014 Undersea & Hyperbaric Medical Society, Inc. INTRODUCTION frostbite is an uncommon but potentially serious event that can occur from exposure to temperatures below -4°C and can lead to extensive tissue damage in other- wise healthy people who are (most likely) part of the working and sporting population [1]. Despite the increase in persons at risk (due, for example, to outdoor activ- ities [2], homelessness [3]), data on the incidence and morbidity are scarce, large randomized clinical trials are not yet feasible and standard treatment guidelines based on a high level of evidence are lacking. A recent treatment guideline from the Wilderness Medical Society was based on a (systematic) literature- guided consensus process, encompassing a large num- ber of international frostbite experts [4]. With respect to hyperbaric oxygen (HBO 2 ) therapy it was concluded that, despite anecdotal evidence of positive effects in a few case reports [1,5,6], due to the absence of con- trolled trials the data are insuficient to recommend HBO 2 therapy for frostbite. To contribute to the knowledge on treatment of this type of injury, we present a report of frostbite injury treated with HBO 2 after a relatively long delay of 21 days. Also provided is an overview of the literature on the effectiveness of hyperbaric oxygen therapy in humans and in animal studies.