Prognosis

While technetium-99m bone scans can help to predict outcome, it usually takes 1 to 3 months to determine the prognosis.[4]​ To determine prognosis, it is useful to classify injured tissue based on the topography of the lesion and early bone scan results, beginning at day 0 (just after rewarming).[1]

  • First- and second-degree injuries usually heal well and have a good prognosis. They do not typically require hospitalisation.

  • Third- and fourth-degree injuries may require amputation months later, after the viability of the tissue is determined. These patients often require hospitalisation and a full work-up because they are at increased risk of amputation and long-term sequelae, including decreased functionality of their limbs.[1][3][9][14]

Good clinical prognostic signs during the healing process are: early recovery of pinprick sensation; healthy-appearing skin; and the presence of clear, rather than haemorrhagic, blebs.[41]

Poor clinical prognostic signs include: haemorrhagic blebs that do not extend distally, cyanosis, and tissue that appears frozen.[Figure caption and citation for the preceding image starts]: Typical frostbite injuries in the hands and feet of a climber with mildly haemorrhagic bullae presenting 3 days after exposure. The bullae were aseptically aspirated and a 5-day iloporost infusion resulted in a complete recoveryHallam M-J, BMJ 2010;341:c5864 [Citation ends].com.bmj.content.model.Caption@263a949

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