HBOT in Frostbite: Less Explored Modality with Excellent Outcome

Background: Extreme cold weather along with certain risk factors, is known to cause ‘Frostbite’ that may lead to potentially serious tissue damage and necrosis. Case Details: A 38 year old non-smoker mountaineer with no known comorbidities and with history of expedition to Antarctica presented with sensory loss over great toe, second, third toe of the left foot and great toe, second toe of the right foot with progressive pain after a Himalayan Expedition at 6,200m altitude. Subsequently, he noticed dark discoloration on the plantar surface of left great toe. He was recommended tablet Pentoxyphyline. Symptoms worsened with numbness, pain and deep seated dark discoloration. After ruling out other possibilities with relevant investigations, he was managed conservatively with Pentoxyphyline, NSAID, Clopidogrel and multivitamins. Due to inadequate treatment response, he was recommended to undergo HBOT. On 12th day after summit, 1st session of HBOT was administered. He underwent 11 sessions of HBOT and was closely monitored and assessed with Galer Jensen Neuropathic Pain Scale (NPS). From the sixth session onwards, there was a significant clinical improvement as documented in the serial NPS. Discussion: Well established, definitive treatment modality for frostbite is still undefined. Neither Undersea and Hyperbaric Medical society (UHMS) nor European Society of Hyperbaric Medicine guidelines recommend HBOT as a treatment modality for frostbite. However, case studies have recommended that HBOT can be used effectively to treat frostbite. This case study supports available literature on possible benefit of HBOT in frostbite. Appropriate and timely administration of HBOT is immensely important to salvage reversibly injured tissues.