Cold and Frost Injuries - Rewarming Damages Biological, Angiological, and Clinical Aspects

This first manuscript on cold injuries was written in the period 1945-1946 as the result of personal experience gained in the winter months of the years 1941-1943 on the Northern Front in Russia and subsequent experimental work at the "Chirurgische Uni­ versitatsklinik" in Breslau (Wroclav) between 1943 and 1945. The intention at the time of writing was to present a summary of our experiences, so that they might serve as a basis for further scientific and clinical work. The manuscript has continually been revised and brought up to date. For purely external reasons publication has been delayed until today. Our experience of cold preservation and of increased resistance to oxygen deficiency in chilled tissue, acquired during the winter periods of the Second World War in Russia, served as a basis for the development of local cryanaesthesia and hibernation, which retroactively furthered to a considerable degree our knowledge of cold and frost injuries. See my monograph on the biology and clinical treatment of the cold injury and general loss of temperature, which appeared separately in 1966 and discusses all biological changes. A comprehensive report on cold injuries was written in English in 1952 at the instigation of Captain A. R. Behnke jr. USA (M.C.), (not available commercially).

Preface.- References.- Clinical Description of Local Cold Injuries.- Internal and External Circumstances Which Encourage Loss of Temperature.- Regional Causes.- General Causes.- References.- Terminology and Division Into Groups of Localised Cold Injuries.- Clinical Manifestations.- Chilblains.- Perniones.- Perniosis.- Erythrocyanosis.- Shelter Leg.- Frostbite, 1st–4th Degree.- Under Normal Climatic Conditions.- At High Altitude (The Effects of Dry Cold Accompanied by Hypoxia).- Deepseated Cold Injury (Loss of Temperature Due to Wet-type Cold Damage).- Comments on Deepseated Cold Injuries at Temperatures Around and Above 0°C and on Ultra Rapid Cooling.- References.- Historical and Statistical Data on Frostbite.- Classification of Cold Injuries.- Forms of Local Frostbite and Areas Likely to Be Affected.- Symptomatology of Localised Cold Injuries.- Phase I of Common Forms of Frostbite Classified According to Degrees.- Phase II: Rewarming and Thawing Out.- Phase III.- Phase IV: Phase of Recovery.- General.- First Degree Frostbite.- Second Degree Frostbite.- Third Degree Frostbite.- Fourth Degree Frostbite.- Deepseated Cold Injuries Without Marked, Externally Visible.- Frostbite Sequelae (Immersion Cold Injuries).- The Problem.- Symptomatology of Trench Foot, Flanders’ Foot and Immersion Hand.- References.- Pathological Physiology and Pathology of Local Cold Damage.- Changes in the Area of the Skin Due to Cold.- References.- Damage to the Nerves Due to Exposure to Acute Cold.- Changes to the Muscles Caused by Cold.- References.- Changes in Bones and Joints.- References.- Vascular Changes.- Relationship Between Peripheral Reactions to Cold and Overall State of the Circulation.- Phases of Cold Reactions in the Vascular System.- Transient Dilatation as an Initial Reaction.- Vasoconstriction.- Irradiation and Consensual Reactions.- State of Primary Bluish Redness and the Stilting Phenomenon.- Bright Red Stage.- Waxy Paleness.- Evidence of an Arteriospasm from an Arteriograph and Other Test Methods.- Stage of Secondary Bluish-grey Discoloration.- Effects of Cold on Lymph Flow.- Electrolytic Changes.- Primary Acidotic Cold Oedema.- Formation of Secondary, Reactive Oedemas.- Manifest Findings Concerning the Vascular System After Cold Damage.- Special Remarks on Vasotrophy, Significance and Nature of the Intima.- Inflammatory Processes in the Vascular Wall.- Cold Endangiitis and Its Relationship to Endangiitis Obliterans.- References.- Eye Disorders Due to Cold.- Changes to the Lungs.- References.- Causes of Cold Necrosis.- Hypoxia and Rewarming Damage.- Necrosis Due to Direct Exposure to Cold.- Role of Catecholamines.- Occlusion of the Venous Pathway and Microcirculation.- The Marked Cold Oedema.- Electrolyte Disturbances.- References.- Complications of Cold Injuries.- Non-specific Complications.- Specific Complications.- Wound Diphtheria.- Tetanus.- Gas Gangrene, Gas Phlegmon, Malignant Gangrene.- References.- Prophylaxis and Treatment of Localised Cold Damage.- Prophylaxis of Localised Cold Damage.- General Information.- Prophylactic Thinning of the Blood by Infusion or Isovolaemic Haemodilation.- Treatment of Localised Cold Damage.- Treatment of Early Cases.- Cool Treatment and the Refrigeration Technique.- Physiological Method of Rewarming.- Slow Active Rewarming.- Rapid Rewarming.- Vasodilators and Spasmolysants.- Fever Treatment.- Reduction of Viscosity by Artificial Thinning of Blood.- Anticoagulants and Fibrinolytics.- Alcohol.- Vitamins.- Rutin and Calcium.- Early Treatment With Oxygen and CO2.- Cortin and ACTH.- Antihistamines.- Combating Pain and the Sedation of the Autonomous Nervous System.- Early Massage and Exercise.- Measures of Dealing With the Marked Oedema.- Blocking of the Sympathetic Nervous System.- General.- Neurovegetative Blocks.- Treatment of Manifest Cold Injuries According to Degrees.- Treatment of 1st and 2nd Degree Cold Injuries and Related Conditions and Additional Treatment With Circulatory and Vasodilating Preparations.- Treatment of 2nd and 3rd Degree Frostbite.- Hydro therapeutic Measures.- Vascular Training.- Ray Treatment (Diathermy, X-rays and Short Waves).- General Principles and Practice Concerning the Surgical Treatment of 3rd and 4th Degree Frost Damage.- Early Operations.- Treatment in One or Two Steps.- Special Nature of Frostbite Amputation.- Amputation in Cases of Wet-type Gangrene.- Comments on the Grafting of Ulcers and Stumps.- Special Information on the Region of the Hand and Fingers.- Special Findings Concerning 3rd and 4th Degree Cold Injuries in the Toe and Foot Area.- Remarks on the Follow-up Treatment and Orthopaedic Care of Local Cold Injuries.- References.- Index of Names.