Triple-phase bone scanning has been used to define the extent of fatally damaged tissues in an attempt to allow for early debridement and wound closure. It is recommended that you perform the bone scan close to day two for all patients who present with lesions extending proximally to include the entirety of one or more phalanges. In the case of severe sepsis, the results of the first bone scan can serve as an indication for emergency amputation. You should perform a second bone scan close to day eight if there is an area of low or absent uptake on the first bone scan. This can provide valuable information on the efficacy of treatment. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) can also provide valuable information for early intervention in cases of severe frostbite. The use of pentoxifylline to minimize tissue damage in the treatment of frostbite has also been recommended. The suggested dosage of pentoxifylline in controlled release tablet form is one 400 mg tablet three times a day with meals. The duration of treatment should be from two to six weeks. Final Thoughts Ultimately, the best way to treat frostbite is prevention. This requires awareness of not only the actual temperature but also the windchill factor (see chart above). Athletes should dress in layers, which allows sweat to evaporate and protects against the cold. Wool, Gore-Tex and lycra are excellent materials to wear. Cotton is the worst. It will actually retain lots of moisture and facilitate heat loss due to convection. It is also important to keep clothing and the inner surface of shoe gear dry in order to avert subsequent chilling from moisture next to the body. If an athlete feels that his or her body part is getting cold, he or she should move it continually, being careful not to keep it in one position for a long time. Jumping up and down and jogging in place are good sideline exercises. Adequate nutrition and hydration status are also essential. Dr. Caselli (pictured) is Vice-President of the greater New York Regional Chapter of the American College of Sports Medicine and is a Professor in the Dept. of Orthopedic Sciences at New York College of Podiatric Medicine.
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