Frostbite of the upper extremity

Progressive tissue injury from frostbite occurs through direct and indirect mechanisms. Direct cellular injury is minimal, whereas indirect injury acc ounts for most tissue damage. Although a variety of methods have been used to limit indirect injury, results have not been predictable, and rapid rewa rming has remained the mainstay of therapy. Early triple-phase bone scans a re useful to identify tissue destined for necrosis and to direct early ampu tation or salvage operations.