Intended for healthcare professionals

Clinical Review

Managing frostbite

BMJ 2010; 341 doi: (Published 19 November 2010) Cite this as: BMJ 2010;341:c5864
  1. Marc-James Hallam, specialist registrar in plastic surgery1,
  2. Tania Cubison, consultant in burns and plastic surgery1,
  3. Baljit Dheansa, consultant in burns and plastic surgery1,
  4. Chris Imray, consultant vascular and endovascular surgeon and honorary professor (Warwick Medical School)234
  1. 1Queen Victoria Hospital, East Grinstead RH19 3DZ, UK
  2. 2Coventry and Warwickshire County Vascular Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  3. 3Warwick Medical School, Coventry, UK
  4. 4Centre for Altitude, Space and Extreme Environment Medicine, University College London, Institute of Child Health, London, UK
  1. Correspondence to: mj_hallam{at}

Summary points

  • Prevention, using a combination of appropriate behaviour and equipment, is key

  • Rewarm frostbite as soon as the risk of refreezing is minimal

  • Seek advice from a specialist unit if the injury is potentially severe

  • Consider thrombolysis (with tissue plasminogen activator) in severe injuries presenting within 24 hours of exposure

  • Delay surgery unless there is evidence of compartment syndrome or overwhelming sepsis

  • People who have sustained a cold injury are more susceptible to a future cold injury

Frostbite is defined as the damage sustained by tissues while subject to temperatures below their freezing point (typically −0.55°C); in the broader sense it can include non-freezing cold injuries, where tissues do not freeze but are subject to a sustained and injurious cooling.1 Cold injuries were historically associated with military work in the field, but in the past 20 years the number of civilian cases has increased.2 3 The unusually cold winters in northern Europe in early 2010 caused many cases of frostbite in the United Kingdom, central Europe, and Scandinavia. The severity of frostbite injury is proportional to the temperature, duration of exposure, and amount and depth of frozen tissue.3 The term frostbite covers a wide range of injuries, from minimal tissue damage to substantial tissue necrosis that can result in amputation. Recent advances in treatment mean that frontline medical staff must be able to recognise and treat frostbite effectively.

Sources and selection criteria

We performed a Medline and Google Scholar search with no date limitations using the terms “frostbite”, “cold injury”, and “freezing cold injury” to obtain references that form the basis of this article. The content of this paper was derived from a variety of sources but we included only articles that were well written, had high clinical importance, and (where relevant) were referenced from soundly conducted clinical trials.

What factors predispose to frostbite?

Factors that predispose …

View Full Text

Log in

Log in through your institution


* For online subscription