Sympathectomy has been advocated in the
therapy of acute
frostbite because
ischemia is one determinant of injury severity. Among 66
frostbite victims treated from 1976 through 1978, a group of 15 patients with acute, bilaterally equal
injuries judged to be third or fourth degree were treated with immediate intra-arterial
reserpine (IAR) in one limb and ipsilateral
sympathectomy. Three additional patients who were excellent candidates underwent immediate
sympathectomy. The average interval from injury to IAR injection was 3 hours (range 1 to 24 hours). The average interval from injury to
sympathectomy was 3 days (range, 12 hours to 10 days). Efficacy of
therapy was assessed by comparison of the sympathectomized limb to the contralateral untreated limb. There was no conservation of tissue, resolution of
edema,
pain reduction, or improved function in sympathectomized limbs compared with those treated with IAR. One patient demarcated more rapidly and one other patient appeared to be protected from recurrent injury.
Sympathectomy was not effective
therapy for acute
frostbite even when achieved early with IAR. Late protection against subsequent
cold injury appears to be the only benefit of
sympathectomy for
frostbite.