Emergency War Surgery NATO Handbook: Part I: Types of Wounds and Injuries: Chapter IV: Cold Injury
United States Department of Defense
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Although a number of physiologic changes induced by cold may explain tissue loss, it is doubtful that they all play a significant part in clinical cold injury. Intracellular molecular changes due to hyperosmolarity, direct metabolic impairment secondary to the cold, and cellular structural damage from the mechanical effect of ice crystals seem far less important than impairment of nutritional blood flow as a final determinant of tissue injury after thawing. Vascular stasis following thaw from freezing injury has been well documented. Clinical and experimental data indicate the importance of capillary blood flow as the determinant of reversibility in tissue freezing.
Alterations in capillary permeability are evident from experimental data and, clinically, from the edema and bleb formation that occur soon after thawing. Endothelial disruption may be responsible for the progressive capillary stasis, plugging, and thrombosis that eventually occur.
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