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TPA and Digital Frostbite: A Literature Review
Lineberry, Kyle
Long, Tobias
Chepla, Kyle
University Hospitals Cleveland/Case Western Reserve
2017-02-09
Presenter: Lineberry, Kyle
Affidavit:
Discussed with Program Director
Director Name: Devra Becker
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Purpose:
Thrombolytic treatment with tissue plasminogen activator (tPA) in the treatment of severe frostbite injury has been demonstrated to improve digital salvage. A number of papers have reviewed the topic in the last 15 years. We sought to review the current literature on TPA use in patients with severe digital frost injury and establish recommendations for indications and use.
Methods:
A review of multiple databases was performed for articles related use of thrombolytics in severe frost injury. All basic science and clinical research articles were included for review in this study. Case reports, expert recommendations, and review articles were excluded from this literature review.
Findings:
A total of 16 manuscripts met our inclusion criteria. The use of thrombolytics for severe digital frostbite was first shown to be efficacious in animal models. Since that time a number of studies have demonstrated improved digital salvage in patients with severe frost injury and clinical evidence of digital vessel treated with arterial thrombolysis. Our review describes those findings and makes recommendations regarding imaging, indications and treatment with regard to the use of intra-arterial thrombolytics in the patient who presents with severe digital frost injury.
