Hyperbaric Oxygen Therapy for a Delayed Frostbite Injury
Hyperbaric oxygen is an approved therapy for 13 pathologic entities. Treatment of frostbite with hyperbaric oxygen is still considered investigational in the United States. Improvement in tissue survival following treatment has been favorably demonstrated in published case reports. This is a case report of severe peripheral frostbite injury in a hiker who presented for hyperbaric oxygen treatments 22 days after her injury. Initially, it was thought that amputation of her fingertips would be necessary. After receiving 21 treatments over a 5-week period, the patient made a complete recovery with only superficial sloughing of skin. Photos document her progress with daily hyperbaric oxygen treatments. A discussion of case reports on the use of hyperbaric oxygen therapy for frostbite is provided, followed by proposed therapeutic mechanisms of action.

The Undersea and Hyperbaric Medical Society (UHMS) currently recognizes hyperbaric oxygen therapy (HBO) as an approved therapy for 13 pathologic entities. These are conditions for which HBO has substantial scientific support demonstrating therapeutic benefit. Hyperbaric oxygen is currently considered a primary treatment modality for carbon monoxide poisoning, cerebral arterial gas embolism, osteoradionecrosis, decompression sickness, and clostridial gas gangrene. It is also considered an adjunctive therapy for acute exceptional blood loss anemia, acute thermal burns, compromised skin grafts or skin flaps, crush injury, compartment syndrome, necrotizing soft-tissue infections, non-clostridial gas gangrene, radiation tissue damage, refractory osteomyelitis, selected problem wounds, and intracranial abscesses.Treatment of frostbite injuries with HBO is considered experimental in the United States. In several published case reports, patients with frostbite appear to have had a favorable clinical outcome in comparison with the expected course of their condition. Case studies point to reduced tissue loss and enhanced healing when HBO is used as an adjunct to standard therapies. The authors describe a case of severe peripheral frostbite injury in a hiker presenting for HBO 22 days after injury.