• Kevin J Bruen, James R Ballard, Stephen E Morris, Amalia Cochran, Linda S Edelman, and Jeffrey R Saffle.
• Department of Surgery 3B-306, University of Utah Health Center, 50 N Medical Drive, Salt Lake City, UT 84132, USA.
• Arch Surg Chicago. 2007 Jun 1; 142 (6): 546-51; discussion 551-3.

HypothesisThrombolytic therapy will decrease the incidence of amputation when administered within 24 hours of exposure.DesignSingle institution retrospective review of clinical outcomes and resource use.SettingBurn unit of a tertiary academic referral center.PatientsFrom 2001 to 2006, patients with severe frostbite admitted within 48 hours of injury underwent digital angiography and treatment with intra-arterial tissue plasminogen activator (tPA) if abnormal perfusion was demonstrated. These patients were compared with those treated from 1995 to 2006 who did not receive tPA.InterventionsTissue plasminogen activator vs traditional management of frostbite injury.Main Outcome MeasuresNumber and type of surgery were recorded, along with amputations of digits (fingers or toes) and more proximal (ray, transmetatarsal, or below-knee) amputations. Resource utilization including length of stay, total costs, cost per involved digit, and cost per saved digit were analyzed.ResultsThirty-two patients with digital involvement (hands, 19%; feet, 62%; both, 19%) were identified. Seven patients received tPA, 6 within 24 hours of injury. The incidence of digital amputation in patients who did not receive tPA was 41%. In those patients who received tPA within 24 hours of injury, the incidence of amputation was reduced to 10% (P<.05).ConclusionsTissue plasminogen activator improved tissue perfusion and reduced amputations when administered within 24 hours of injury. This modality represents the first clinically significant advancement in the treatment of frostbite in more than 25 years.

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