Gelures et nécroses distales

Frostbites are the most severe form of localized cold-related damages. Historically it has been a disease of wars and mountain practices; nowadays the majority of cases affects vulnerable civil populations. Frostbites are the consequence of a severe cutaneous vasoconstriction and of the progressive frost of the tissues when the skin temperature goes below the plasma freezing point at -0.52°C. The reversibility of the process depends upon the intensity and duration of the exposure to the cold, the precocity of the awareness of the critical situation, and the possibility to be taken care of rapidly. Rapid rewarming is the first step of treatment and allows to make a prognosis and to define the management of the case. The short term local risk is necrosis or dry gangrene through an irreversible microvascular and cellular injury process ischemia-reperfusion like. The global risk depends upon the comorbidities. Late disabling sequelae in extremities (sensitivity, articulations) are frequent even in moderate forms of frostbite.