COLD INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 411

frostbitten extremities that they insist upon immediate amputation. Tragic mutilations have
occurred.Manyindividualshaverefusedamputationandrecoveredwithminimalornotis-
sue loss.
With essentially no exceptions, surgery must be delayed until demarcation of the dead
tissues is complete and unmistakable. At that time minor surgical debridement of infected
escharsorincisionofconstrictingescharsthatcompletelysurroundadigitandareobstruct-
ingcirculationmaybeneeded.However,surgeryisusuallynotrequireduntillongafterthe
initial injury, and then only to complete amputation of frostbitten tissues or to reconstruct
hands or feet. “Frozen in January, amputate in June” is a time-proven adage.
Individuals who have suffered frostbite usually have increased sensitivity to cold and
are more susceptible to cold injury because the blood vessels in the injured tissues have
been permanently damaged.
TRENCHFOOT
Trenchfoot is a nonfreezing cold injury that is almost entirely a military problem, although
rareinstances incivilians areencountered. IntheFalklandIslandsfightingin1982,14per-
cent (70 of 516) of the hospitalized British battle casualties had trenchfoot. Only soldiers
with the most severe injuries were hospitalized; estimates of the number with lesser injur-
ies ranged as high as 2000.
Trenchfoot results from feet being wet and cold without interruption for days or weeks.
The feet do not have to be immersed in water; simply being wet produces the condition.
Symptoms rarely appear in less than four or five days, and even then only in severely cold,
windy weather—as was encountered in the Falklands.
The disorder was first described during the Napoleonic campaigns, particularly during
the retreat from Moscow, but received its name during World War I from the infantrymen
whospentweekswiththeirfeetinthecoldwaterthatfloodedthetrenches.TheBritishhad
over 115,000 casualties from trenchfoot and frostbite in that conflict. Similar injuries in in-
dividuals who spent weeks with their feet in cold water in rafts or lifeboats after their ships
had been sunk or their aircraft had crashed led to the name “immersion foot.” Other names
exist, but trenchfoot is the most clearly and widely recognized.
The cold induces intense vasoconstriction, which deprives the feet of adequate blood
supply. (The separate roles of cold and poor circulation in producing injury have not been
distinguished.) After five to seven days (or longer) the feet become red, swollen, and quite
painful. British soldiers with trenchfoot in the Falklands screamed in pain when putting
their boots on in the morning (but stormed into battle anyway!).
Treatment is simple except for severe cases. It consists of keeping the individual warm
with feet dry, elevated, and protected from bedclothes. Nothing more. Severe cases should
be treated like frostbite, although the tissues do not need to be rewarmed.