Cold injuries are caused by prolonged exposure to extremely low temperatures or accidents at work resulting in sudden exposure to extreme temperatures. They can occur with or without body tissues freezing and may result in the loss of limbs.
Cold injuries can be classified as follows:
Frost-nip – Mildest type of cold injury; involves pain, as well as pallor and numbness. Can be reversed through re-warming and usually does not result in the loss of tissue, but may cause atrophy or fat pad loss if repeated over several years.
Frostbite – Tissue is frozen with microvascular occlusion, followed by tissue anoxia. Re-warming may cause reperfusion leading to further tissue damage. There are four degrees of frostbite:
- First degree frostbite: hyperaemia; oedema; no necrosis of the skin
- Second degree frostbite: hyperaemia, oedema; partial-thickness necrosis of the skin; formation of large clear vesicles
- Third degree frostbite: full thickness skin necrosis; subcutaneous tissue necrosis; frequently accompanied by haemorrhagic vesicles
- Fourth degree frostbite: full thickness skin necrosis; subcutaneous tissue necrosis; also affects muscles and bones with gangrene
Trench foot: Non-freezing cold injury affecting hands or feet caused by continual exposure to cold temperatures (slightly above freezing) and wet conditions. Affected area may appear completely black, but without deep tissue destruction. Progressing to hyperaemia within approximately 24 to 48 hours may cause intense burning and dysaesthesia, and tissue damage may result in blistering redness; bruising, oedema or ulceration. Complications may include cellulitis; gangrene, local infections or lymphangitis.
Chilblains (pernio or perniosis): Typically appearing on the hands, feet, tibial surface or face, chilblains may be acute (developing within around 12 to 24 hours after exposure and lasting for up to 2 weeks) or chronic (occurring after repeated exposure and causing persistent lesions that may lead to scarring and atrophy). Lesions are reddish-purple and pruritic (itchy). Continued exposure may result in haemorrhagic or ulcerative lesions that may progress to atrophy, fibrosis and/or scarring.
Combined with wound-related sepsis or hypothermia, cold injuries may be fatal. Complications may include:
- Hyperglycaemia, acidosis
- Secondary wound infections
Possible long-term complications may consist of:
- Anhidrosis or hyperhidrosis
- Cold sensitivity
- Joint stiffness
- Loss of nails
- Cracking of skin
- Muscle atrophy
- Permanent scarring
Following cold exposure
If you suffered a cold injury at work, Accident Advice Helpline may be able to help you claim for work injury compensation. Contact us today for more information on 0800 689 0500 or on 0333 500 0993 from your mobile.
Date Published: February 27, 2015
Author: Accident Advice