MORPHOLOGICAL FEATURES OF TISSUE CHANGES IN FROSTBITE OF THE EXTREMITIES

The purpose of the study. To study the morphological features of changes in the tissues of the demarcation zone during frostbite of the extremities.

Materials and methods. Histological examination of tissues was carried out in 84 patients with frostbite of the II-IV degree of the upper and lower extremities in the area of the hands and feet, on the 30th day from the moment of injury, who were treated at the State Medical Institution "City Clinical Hospital No. 1" in Chita. Fragments of tissue measuring 1x1x0. 5 cm were taken with a scalpel under local anesthesia during surgical treatment in the deep lesion zone at the border of damaged and healthy tissues in the demarcation zone. For the study, the material was fixed in a 10% solution of neutral formalin, followed by pouring into paraffin according to the standard method. Prepared histological sections with a thickness of 4-5 microns were stained with hematoxylin and eosin. A descriptive method of drug research was used.

Results. With frostbite of the extremities, the skin with the underlying tissues, blood vessels, bone, cartilage tissues, in which inflammatory, necrotic processes, sclerosis predominate, are most susceptible to changes. Minimal morphological changes are observed in skin derivatives (sebaceous, sweat glands, epithelium of hair  sheaths),  tendons,  peripheral  nerves  with  a  predominance  of  dystrophic  changes.  The  leading pathomorphological process in the vessels with frostbite of the extremities is sclerosis of the vascular wall, which is caused by the processes of endarteritis, endophlebitis and thrombophlebitis. An important role in the development of destructive changes in tissues during frostbite is played by common thrombosis, which results in tissue hypoxia, secondary morphological changes in tissues that cause the severity of the injury.

Conclusion. The unevenness of tissue damage in the demarcation zone during frostbite was revealed. The most pronounced lesions are skin, muscle, bone, cartilage, blood vessels. The sebaceous, sweat glands, hair follicles and nerves are less susceptible to changes. This is due to the peculiarities of blood circulation in the tissues  and  the  need  for  some  of  them  for  intensive  blood  supply.  In  this  regard,  severe,  irreversible inflammatory and necrotic changes develop in tissues with an abundant blood supply, up to gangrene. And in structures with poor blood supply, focal, dystrophic, reversible processes are noted.

1. Alekseev A.A., Alekseev R.Z., Bregadze A.A. Diagnosis and treatment of frostbite (clinical recommendations). (cited 2021 June 24). Available from: http://combustiolog.ru/wp-content/uploads/2013/07/Diagnostika-ilechenieotmorozhenij-2017.pdf. in Russian.

2. Alekseev R.Z. Prevention of the development of necrosis in frostbite with tissue glaciation. International Journal of Applied and Fundamental Research. 2015. 8 (1). 35–41. in Russian.

3. Aryev T.Ya. Frostbite. Pathological anatomy, pathological physiology, pathogenesis, clinic, prevention, treatment. Leningrad: State Publishing House of Medical Literature. 1938. in Russian.

4. Vasina L.V., Vlasov T.D., Petrishchev N.N. Functional heterogeneity of the endothelium (review). Hypertension. 2017.23. (2). 88–102. Doi: 10.18705/1607-419X-2017-23-2-88-102. in Russian.

5. Vinnik Yu.S., Salmina A.B., Yuryeva M.Yu., Teplyakova O.V. Local cold trauma: issues of pathogenesis, severity assessment and treatment. Moscow Surgical Journal. 2011. 1. 42-48. in Russian.

6. Vinnik Y.S., Yurieva M.Y., Teplyakova O.V., Salmina A.B., Tretyakova N.G. The value of endothelial dysfunction in the pathogenesis of local cold injury. Russian medical journal. Medical review. 2014. 22. (31). 21–23. in Russian.

7. Vitkowsky Y.A., Kuznik B.I., Solpov A.V. Pathogenetic significance of lymphocyte-platelet adhesion. Medical immunology. 2006. 8 (5-6). 745-753. in Russian.

8. Vikhriev B.S., Kichemasov S.H., Skvortsov Yu.R. Local cold lesions. Medicine. 1991. in Russian.

9. Gruzdeva O.S. Pathological anatomy of frostbite. Zabaikalsky Medical Bulletin. 2020. 4. 137-144. in Russian.

10. Kotelnikov V.P. Frostbite / V.P. Kotelnikov.  Moscow: Medicine, 1988. ISBN 5-225-00163-7. in Russian.

11. Murazyan R.I., Smirnov S.V. Frostbite of the extremities. M. Meditsina, 1984. in Russian.

12. Nikolaev V.M., Alekseev R.Z., Fedorova S.A. Intensity of free radical oxidation of lipids in the body of patients with cold trauma. Yakut medical journal. 2018. 2 (62). 34–38. in Russian.

13. Atlas of thermal lesions. V.A. Sizonenko, K.G. Shapovalov, A.M. Miromanov, S.A. Sumin-Moscow: GEOTAR-Media, 2017. in Russian.

14. Sizonenko V.A. Cold trauma. Chita: Express Publishing House. 2010. in Russian.

15. Sizonenko V.A. Cold injury. Bulletin of the VSCC SB RAMS. 2007. 4. 98-101. in Russian.

16. Shapovalov K.G. Frostbite in the practice of an anesthesiologist-resuscitator. Bulletin of Anesthesiology and Resuscitation. 2019. 16. 1. 63-68. DOI: 10.21292/2078-5658-2019-16-1-63-68. in Russian.

17. Shapovalov K.G., Sizonenko V.A., Burdinski E.N. Changes in vascular tone and indicators of microcirculation in frostbite of the lower extremities. Bulletin of Surgery named after I.I. Grekov. 2008. 5. 67–68. in Russian.

18. Erdes Sh.F., Krasnenko S.O., Urumova M.M. Joint damage after frostbite (case description). Scientific and practical rheumatology. 2018. 56 (4). 515-518. in Russian.