Frostbite of the feet after cryotherapy: a report of two cases.

UNLABELLED: The use of cryotherapy for the reduction of postoperative swelling and pain has become commonplace in orthopedic, podiatric, and cosmetic surgery. Prolonged exposure to extreme cold may induce an injury nearly identical to that of frostbite. The authors report on 2 patients who underwent podiatric orthopedic surgery and were exposed to prolonged cold therapy, which resulted in limb-threatening problems. Both patients had prolonged and essentially uninterrupted application of cryotherapy for 4 to 7 days, resulting in rewarming injuries of tissue necrosis. A team of specialists used limb salvage therapy to successfully treat the patients. Because of the problems encountered with the cold therapy devices, the authors caution against unmonitored and prolonged cold exposure. Newer devices that prevent cold exposure below 65 degrees F for longer than 2 hours could be a better option in cases in which cryotherapy is used. LEVEL OF EVIDENCE: 4.