Cold Burn

Cold burn or Frostbite occurs when the skin is in touch with an extremely cold body. Extreme cold can cause damage to the skin and underlying tissues. For example, if there is a prolonged contact of the skin with moderately cold body like snow or very cold bodies like dry ice, liquid helium or liquid nitrogen for a brief period, cold burns or ice burns will occur. Here heat is transferred from the skin and organs to the cold body that is in contact. In other kinds of burns, the body that causes the burn is hotter and heat is transferred to the skin or the organ.

Symptoms of frostbite include pins and needles sensation and then numbness in the area. Initially there may be throbbing or aching. The affected part seems to become insensate. In severe frostbite, when the tissue starts to freeze, the skin at that area may appear white and numb. In areas affected by frost burn, abnormal accumulation of blood takes place. In addition to accumulation of body fluids, a blood clot may form thereby preventing blood circulation around the area resulting in tissue decay. Mottled and violaceous tissue is noticed. Normal functioning of the body is disturbed because of cooling of the internal organs, which will lead to a critical condition called hypothermia. Cooling of the brain or heart is very dangerous.

The accumulated plasma in the blister is intended to prevent further damage and also to help in the healing process. To avoid infection from the blister, it is important that it is not punctured as it would expose the raw skin for further infection. The serous fluid will be reabsorbed by the skin usually after 24 hours if there is no infection.

Severe frostbite may also damage tendons, muscles, nerves and bones. Gangrene is inevitable in the case of very severe frostbite. Frostbite may affect any part of the body.

The most vulnerable parts are hands, feet, nose and ears. Recovery may be significant when the skin and underlying body tissues are injured and it may be permanent if there is injury to the blood vessels. If gangrene follows, the affected part may have to be amputated. When warming up of the affected part begins, the patient will experience intense pain. There will be tingling or burning sensation in the affected area also.

People taking beta-blockers that decrease blood flow to the skin and those who suffer Peripheral Vascular Disease are at risk when exposed to cold for a prolonged period. Any person who is exposed to extreme cold for a long period is susceptible to frostbite. Diabetes, peripheral neuropathy or Raynaud's phenomenon are some conditions that may have increased risk of cold burns. Smoking and windy weather when the rate of heat loss from the skin is more will hinder the healing process. Cold burns at the work place are common. People who work in factories where they may come in contact with metal surfaces that are at extremely cold temperatures are prone to cold burns. When the skin is moist, they may receive almost instantaneous cold burns.

Prevention of freeze burns

Extreme cold, wet clothes, high winds and poor circulation are some of the factors that can contribute to freeze burns. Tight boots or clothing and conditions like cramped positions, some medications, smoking or alcohol can cause frostbite. Wearing appropriate clothing in winter when the temperature goes below normal and will help. Winter clothes like mittens, layered clothing that is wind-proof and water resistant gives good protection.

First Aid for cold burns

It is essential that the ice burn treatment is correctly done as soon as possible.

• If you anticipate prolonged exposure to cold, avoid alcohol or smoking and take sufficient food and rest. Increase physical activity that maintains body temperature and find shelter in a snowstorm as early as possible.
  
  
• Victims should be moved to a warmer place to give shelter from the cold. Constricting jewelry and wet clothes should be removed. If there are symptoms of hypothermia, treat it immediately.
  
  
• Wrap the affected areas using sterile dressings. Dressings should be done after separating affected fingers and toes.
  
  
• In case immediate care is unavailable, you can go for re-warming first aid. This can be done by immersing the affected parts in warm water. Otherwise repeated application of warm clothes to injured ears, cheeks or nose for 20 to 30 minutes helps. Water temperature should be kept between 104 to 108 degrees F. To aid the warming process, the water should be kept circulating. During the warming process, swelling, color changes and severe burning pain may be noticed. The wound will heal when there is a slow heat transfer from water to the affected part.
  
  
• The frost bitten areas should be dressed with dry, sterile dressings. Remembering to keep the fingers or toes separated is important.
  
  
• Thawed areas should not be moved as far as possible.
  
  
• In case of extensive freeze burns, giving warm drinks to the victim helps in replacing lost fluids.
  
  
• Wet clothing must be removed and replaced with warm clothing.
  
  
• Until you reach a warm and safe location, do not go for re-warming process. There is the danger of severe damage because of re-freezing of thawed extremities.
  

Frostnip is the least severe form of cold injury that occurs after the distal extremities are exposed to prolonged period of cold but non-freezing temperatures. Vasoconstriction is felt. Frostnip is a precursor to frostbite and does not involve the same levels of tissue destruction. The affected area appears pale.

Immersion foot is a condition where there is severe tissue injury due to prolonged and persistent exposure to wet conditions, cold or hot. It results in tissue edema and inflammation. This is often seen in homeless persons who are exposed to the elements. The extremities appear swollen and erythematous (skin turning red often manifested in patches). Bad odor is often noticed as also tissue sloughing.

Cryosurgery

Cryosurgery is increasingly becoming popular especially in the removal of tumors. Cryosurgery involves the administration of liquid nitrogen at very low temperature to remove tumors and cancerous tissues by cell death. This method is also called as cryogenic cell death. Cryosurgery is also used in the treatment of precancerous tumors in cervical cancer.

Cryosurgery Procedure

Cryosurgery is usually performed when the patient is in a conscious state. Different types of cryoprobes are used to treat cancers or tumors associated with specific regions in the body. Once the cry probe is introduced in the body, the compressed liquid nitrogen with a temperature ranging from -20°C to -50°C is passed into it to freeze and destroy the unwanted tissue through contact. The cells are subject to osmotic pressure changes because of the increased fluid content caused by the cry probe. Cryosurgery is done at regular intervals to promote thawing of the tissue and subsequently freezing it to destroy the layer of cells that are not required.

Precautions and side effects of Cryosurgery

In most cases, an interval of three minutes is given throughout the procedure. The probe inactivates the nerve endings touching the adjacent cells to inhibit the sensation of pain caused by the abnormal tissue. Vascular changes also occur during the procedure such as initial numbness and flushing sensation during the thawing process. Cryosurgery is most suggestive in case of precancerous stages as it enables treatment of the cancerous tissue effectively. It is predominantly used in the treatment of Neuroma, prostate cancer, cervical cancer and skin cancer. Patients generally complain cramping sensation during the procedure which usually subsides on its own.

Other complications include infection and swelling. Since cryosurgery does not require major invasion, the side effects are minimal. Cryosurgery can be done both as external and internal procedure. The healing patterns after the procedure vary from one area of the body to another. In case of skin cancers or melanomas, the deterioration of the unwanted warts and subsequent tissue rejuvenation may take up to six weeks. Malignant melanomas are not treated by using cryosurgery.

Cryosurgery cannot be performed for all types of cancers and on all organs, because of the probability of normal tissue damage and formation of unwanted scarred tissues. Careful analysis is done by the physician to identify the form of tumor and the type of cells associated. Biopsy is performed to detect any form of malignancy or metastases of the respective cancer. Salicylic acid is applied on the warts prior to cryosurgery to reduce the size. In some cases cryospray is used directly on an external growth for a period of 20 to 30 seconds.

Although cryosurgery is one of the most preferred techniques, elderly persons are not suitable for this procedure. Most patients undergoing cryotherapy experience blisters, itching and oozing for a short period of time. Precautions are taken to avoid any form of secondary infection. Cryosurgery associated with skin cancers such as basal cell carcinoma, have side effects such as hypo pigmentation and hyper pigmentation. In some rare cases nerve damages have been reported. Studies indicate that patients who have a history of human papilloma virus infection also prefer cryosurgery for the removal of genital warts.

Retinal Detachment

The retina is critical to your eyesight since it sends messages to the brain via the optic nerve. When the retina gets separated from the back wall of the eye, it leads to a condition of retinal detachment. Retinal detachment leads to loss of function of the retina due to loss of blood supply and nutrition. It is imperative that a condition of retinal detachment be attended to immediately to avoid permanent loss of vision. Some patients may suffer a condition where there is a tear in a small area of the retina. Rhegmatogenous detachment of the retina occurs when there is a tear in the retina. On the other hand, tractional retinal detachment is caused due to scar tissue on the retina. When retinal detachment occurs due to an inflammatory disease or injury, it is a case of exudative retinal detachment.

Retinal detachment can be caused due to advanced diabetes or an inflammatory disease. Trauma can also cause the retina to get detached. Any leakage of vitreous liquid accumulating under the retina can cause the retina to get detached. This can happen due to aging. Persons who suffer weak areas in the retinal periphery or have undergone severe eye injury are at risk for retinal detachment. Signs of retinal detachment include sudden flashes of light in the affected eye and blurred vision. Many floating debris might appear in the vision.

The size and location of the retinal detachment decides the kind of treatment that would be most suitable. Small retinal tears are treated with cryopexy or retinal cryotherapy that involves freezing of the area around the tear. Laser surgery is used to fuse the retina to the underlying tissue. Laser surgery can be done sans incision and the patient suffers minimal discomfort. More complex cases would require vitrectomy and scleral buckling procedures to seal the detached retina. Surgery is not always a guarantee of restored vision as it's success hinges on how much of the retina is detached and for how long.