Severe Frostbite in Extreme Altitude Climbers

A 54-year-old American man summited Everest in May 2016. During descent, he realized that his hands and feet, particularly the right hand and right foot, were frozen. During the summit push, he used only his right hand to hold onto the ropes. He rewarmed his right hand and right foot at camp 4 (8000 m). The next day, he walked to camp 2 (6400 m) and was evacuated to Kathmandu. He was not sure if refreezing might have occurred during descent to camp 2. He had been taking 80 mg of aspirin, a potassium supplement, and a multivitamin daily, and an occasional acetazolamide. On admission, the right foot had black discoloration of all 5 toes extending up to the proximal phalanx, consistent with grade 3 injuries (Figure 1). Similar frostbite injuries were also noted in the second through fifth fingers of the right hand and third finger of the left hand consistent with grade 2 injuries of 5 digits (images of hands not shown). Technetium-99 scintigraphy done immediately after patient arrival (vascular phase only) showed no perfusion in the toes of the right foot, nor in the 5 affected fingers. Time from injury to iloprost was between 48 and 52 h. Iloprost infusion was started and continued for 5 d. He experienced symptoms of flushing and headaches during infusion that required dose reduction during the first 2 d and symptoms resolved. At 3 mo, 8 of 10 of his frostbitten digits were partially amputated (Figure 1, right foot only).

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Figure 1. Grade 3 frostbite of all toes of the right foot. Photos: top row, at 72 h and 6 d (day 3 of iloprost infusion) bottom row, 1 mo and 3 mo.
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