Immersion Foot: A Case Report.

BACKGROUND: Immersion foot (commonly called "trench foot") was originally described in the military literature during World War I. Since that time, the emergency department (ED) has become a common setting where this injury presents. However, this topic is neglected in the emergency medicine literature. The purpose of this case report is to present trench foot in a way that is relevant to emergency physicians and to provide an up-to-date summary of the history, case reports, physiology, clinical presentation, and treatment of this injury. CASE REPORT: Here we present the case of a homeless, schizophrenic patient who presented to one Midwestern ED in January for immersion foot. Photos of the actual patient are shown to illustrate the case. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Due to unfamiliarity, immersion foot can go undiagnosed during assessment of patients exposed to moist environments. In addition, patients at increased risk for developing immersion foot are frequently encountered in EDs. Most importantly, the appropriate treatment for immersion foot is different than the treatment for other freezing cold injuries.

["Teruel feet". Care and treatment of frostbite wounds in the hospitals of Navarra during the civil war]. / "Los pies de Teruel". Asistencia y tratamiento de las heridas por congelación en los hospitales navarros durante la guerra civil.

The care of combatants with lesions caused by frostbite during the battle of Teruel, which was fought in extreme weather conditions and in temperatures as low as twenty degrees below zero, was the period of greatest medical activity and the highest rates of occupation in the military hospitals of Navarre during the civil war of 1936-1939. From November 1937 to March 1938, 375 cases of frostbite were registered in the provincial establishments, amongst which there was a predominance of cases of dry gangrene partially affecting the lower extremity, which was popularly known as "Teruel feet". Some of the medical staff, conscious of the exceptional nature of the casuistry, registered statistics, clinical cases and personal impressions of the evolution of the lesions and the effectiveness of the treatments. In treating this affectation they employed medicines, surgical techniques and novel therapeutic procedures that were not widely used in the medical milieu of the time. However, the limited duration of the problem, the inconclusive results of the treatments and the differing opinions on their effectiveness -questions that are considered in this article- restricted the subsequent medical repercussion of the experiences of frostbite developed during the wartime period in Teruel.

'Los pies de Teruel'. Asistencia y tratamiento de las heridas por congelación en los hospitales navarros durante la guerra civil / 'Teruel feet'. Care and treatment of frostbite wounds in the hospitals of Navarra during the civil war

La atención a combatientes con lesiones por congelación sufridas durante la batalla de Teruel, desarrollada en condiciones meteorológicas extremas y temperaturas de hasta veinte grados bajo cero, supuso la etapa de mayor actividad asistencial y tasas de ocupación más altas en los hospitales militares navarros durante toda la contienda civil de 1936-1939. De noviembre de 1937 a marzo de 1938 se registraron en los establecimientos de la provincia más de 375 casos de congelación, entre los que predominaban las gangrenas secas con afectación parcial de la extremidad inferior, lo que popularmente se denominó 'pies de Teruel'. Algunos facultativos, conscientes de la excepcionalidad de la casuística, registraron estadísticas, casos clínicos e impresiones personales sobre la evolución de las lesiones y la efectividad de sus tratamientos. En ellos, emplearon fármacos, técnicas quirúrgicas y procedimientos terapéuticos novedosos en el tratamiento de esta afección y poco difundidos en el entorno médico del momento. Sin embargo, la limitación temporal del problema, los resultados poco concluyentes de los tratamientos y las opiniones controvertidas sobre su efectividad, cuestiones que se analizan en este artículo, limitaron la repercusión médica posterior de las experiencias sobre congelaciones desarrolladas durante la etapa bélica turolense

The care of combatants with lesions caused by frostbite during the battle of Teruel, which was fought in extreme weather conditions and in temperatures as low as twenty degrees below zero, was the period of greatest medical activity and the highest rates of occupation in the military hospitals of Navarre during the civil war of 1936-1939. From November 1937 to March 1938, 375 cases of frostbite were registered in the provincial establishments, amongst which there was a predominance of cases of dry gangrene partially affecting the lower extremity, which was popularly known as 'Teruel feet'. Some of the medical staff, conscious of the exceptional nature of the casuistry, registered statistics, clinical cases and personal impressions of the evolution of the lesions and the effectiveness of the treatments. In treating this affectation they employed medicines, surgical techniques and novel therapeutic procedures that were not widely used in the medical milieu of the time. However, the limited duration of the problem, the inconclusive results of the treatments and the differing opinions on their effectiveness –questions that are considered in this article– restricted the subsequent medical repercussion of the experiences of frostbite developed during the wartime period in Teruel

Neuropathy in non-freezing cold injury (trench foot).

Non-freezing cold injury (trench foot) is characterized, in severe cases, by peripheral nerve damage and tissue necrosis. Controversy exists regarding the susceptibility of nerve fibre populations to injury as well as the mechanism of injury. Clinical and histological studies (n = 2) were conducted in a 40-year-old man with severe non-freezing cold injury in both feet. Clinical sensory tests, including two-point discrimination and pressure, vibration and thermal thresholds, indicated damage to large and small diameter nerves. On immunohistochemical assessment, terminal cutaneous nerve fibres within the plantar skin stained much less than in a normal control whereas staining to von Willebrand factor pointed to increased vascularity in all areas. The results indicate that all nerve populations (myelinated and unmyelinated) were damaged, possibly in a cycle of ischaemia and reperfusion.

Pie de trinchera: revisión del tema y experiencia en Las Malvinas / Trench foot: general review and experience in Malvinas

Este trabajo reúne la experiencia del Hospitasl Militar de Puerto Argentino en lesiones por el frío ocurridas duerante el conflicto por las Malvinas, con 173 casos. Nuestras tropas fueron aferradas en posiciones defensivas en los pozos de zorro por el fuego de la artellería y aviación enemigas. Esto, sumado a las condiciones climáticas adversas, contribuyeron a la incidencia del pie de trincheria. Cerca del 90% de los casos ocurrieron en soldados. El pie de trinchera afectó principalemtne a los hombres de infantería, con el 67,7%

Pie de trinchera: revisión del tema y experiencia en Las Malvinas / Trench foot: general review and experience in Malvinas

Este trabajo reúne la experiencia del Hospitasl Militar de Puerto Argentino en lesiones por el frío ocurridas duerante el conflicto por las Malvinas, con 173 casos. Nuestras tropas fueron aferradas en posiciones defensivas en los pozos de zorro por el fuego de la artellería y aviación enemigas. Esto, sumado a las condiciones climáticas adversas, contribuyeron a la incidencia del pie de trincheria. Cerca del 90% de los casos ocurrieron en soldados. El pie de trinchera afectó principalemtne a los hombres de infantería, con el 67,7% (AU)

Vascular compartment syndromes.

In a 5-year period (1968 to 1973) 33 cases of vascular compartment syndrome were seen. Seven case reports illustrate various etiopathogenetic factors in the development of vascular compartment syndrome. A review of the 33 cases has permitted discussion of the pathophysiology and clinical features of these syndromes, together with introduction of a clinical classification on which treatment is based. Mild cases may be treated by application of ice, elevation, and observation; for severe cases fasciotomy is the treatment of choice. Two techniques of fasciotomy are available: multiple skin incisions with fasciotomy between the incisions for single-compartment sydnromes and extensive skin incisions over the length of the fasciotomy for multicompartment syndromes or severe single-compartment syndromes.