Introduction: We tested the hypothesis that individual susceptibility to freezing cold injury might be reflected in an attenuated cold-induced vasodilatation (CIVD) response by comparing the CIVD responses of an elite alpinist with a history of freezing cold injury in the feet (case alpinist) with those of an age- and ability- matched noninjured alpinists control group (controls). According to this hypothesis, the vasomotor responses to a CIVD test of the case alpinist would represent a pathophysiological response when compared with the normal physiological response of a noninjured cohort. Methods: The case alpinist and the controls in the cohort group conducted a cold water immersion test comprising sequential immersion of a hand and foot for 5 min in 35°C water, followed by a 30-min immersion in 8°C water and a 10-min recovery period in room air. During this test we monitored the finger and toe skin temperatures. Results: The case alpinist had a significantly attenuated CIVD response and a lower skin temperature in all injured and noninjured digits during immersion (∼2°C lower than in the control group) and an attenuated recovery of finger skin temperatures (∼6°C lower than in the control group). Conclusions: The attenuated CIVD response of the case alpinist may reflect a previously unrecognized enhanced susceptibility to frostbite. In addition to the poor vasomotor response observed in the injured toes, he also exhibited a poor vasomotor response in his noninjured fingers. The results of the present study indicate that a test of vasomotor activity during thermal stress may identify individuals predisposed to cold injury.

Background and Objectives: A surgical method is rarely very effective and simple to perform. A Lichtenstein Repair (LR) is one such exception. Because of the very high incidence of inguinal hernia, LR has become the global gold standard in inguinal hernia repair—not only due to its relative simplicity and reproducibility but also because it can be performed under local anesthesia. These attributes facilitated its worldwide adoption, including in underdeveloped and resource limited settings. Today, many variations are performed under the common name “Lichtenstein Repair”. The extent to which these modifications influence outcomes—particularly recurrence and chronic pain—remains unclear. Materials and Methods: To evaluate reasons for variation in the LR technique, a literature review of seven major surgery textbooks was performed. In addition, a questionnaire comprising 17 questions addressing the key steps of the LR was sent to 90 surgeons across 19 different hospitals in Austria (6) and Slovenia (13). The questionnaire focused on core principles described by Lichtenstein and later refined by his successors. The overall response rate was 78%. Results: Descriptions of the LR in major hernia textbooks vary substantially, partly due to the evolution of the technique over time and partly because any subaponeurotic anterior-canal mesh repair is often labeled as “Lichtenstein”. Survey responses demonstrated considerable variation and lack of standardization or uniformity in several critical steps of the LR. More than 50% of respondents reported using pre-formed meshes that they excessively trim, limiting adequate coverage of the inguinal region. Furthermore, routine patient follow-up is lacking in the majority of cases. Conclusions: The contemporary umbrella term “Lichtenstein Repair” encompasses many different anterior mesh techniques. While some surgeon-specific preferences may not compromise integrity, strict adherence to the evidence-based key principles of the original repair remains essential to minimize recurrences and chronic inguinal pain. Standardization with meticulous adherence to the key principles of the LR is critical to ensure the data submitted into registries, RCTs, and meta-analyses are accurate, comparable, and meaningful.

Introduction: Frostbite is a condition that mostly affects skin, but also the underlying tissues, resulting from prolonged exposure to temperatures below freezing point (-0.55°C). Although frostbite has been a known phenomenon for several millennia, the exact incidence of frostbite is not known. This is partly due to variable internal and external etiological factors. One of the many consequences of climate change are extreme cold events, which increase the risk of frostbite in the general population, particularly among individuals who are involuntarily exposed to cold for prolonged periods of time. Severe cold injury can lead to deep frostbite with irreversible sequalae such as amputations. Objectives: The reviews objective is to compare data collection and incidence rates of frostbite in different studies and populations. Methods: Out of a total of 61 studies using the keywords "frostbite" and "incidence", 7 were selected that dealt with frostbite causes and incidence over 20 years. The studies results were briefly summarized and their conditions were compared. Results: Frostbite can damage tissue superficially or deeply, depending on its degree. The results of the seven studies show a great variation of frostbite incidence depending on population, its size, and method of data collection. Studies that include the entirety of the civilian population show significantly lower frostbite incidence rates than studies focusing individuals who are exposed to temperatures below -0.55°C for long periods of time, such as mountaineers, military personnel, or homeless people. Although cold injuries are rare, they are becoming increasingly problematic for individuals who are exposed to a cold environment for prolonged periods of time due to climate change. This includes homeless individuals, outdoor workers in cold regions, alpinists and persons with inadequate equipment. The results underline different incidence rates for different populations and show that retrospectively collected data are insufficiently comparable. Enhanced frostbite susceptibility in some individuals should also be considered in the future in order to estimate the frostbite incidence more accurately. Moreover, defining frostbite susceptibility in advance could prevent frostbite incidence in the future to some degree, especially in military operations in the cold and certain leisure activities (e.g. mountaineering). Conclusions: Frostbite poses a significant risk in cold regions and can lead to severe complications without adequate protection. To enhance our ability to predict frostbite occurrences within the general population, it is crucial to understand its incidence in relation to climatic factors. Establishing an international or national frostbite registry in high-risk countries could effectively guide preventive measures and safeguard individuals. This registry should encompass frostbite occurrences alongside contextual elements, such as freezing temperatures and cold exposure duration. Moreover, comprehensive weather conditions like wind chill, precipitation, humidity, and cloud cover must also be considered. When similar external conditions result in frostbite, investigating protective measures becomes pivotal. Furthermore, researching individual susceptibility to cold is essential to discern variations in frostbite vulnerability, especially for activities in cold environments.

Background: Frostbite is a localized cold injury resulting from tissue freezing, primarily affecting the extremities. Although rare in the general population, it is more frequent among individuals exposed to extreme cold, such as soldiers and mountaineers. Severe cases can result in permanent disability and tissue loss. Objective: To provide a narrative overview of current evidence-based recommendations for the prevention and treatment of frostbite, based primarily on recent guideline updates from the Wilderness Medical Society (2024) and the American Burn Association (2024).Methods: This narrative review summarizes and compares recommendations from two major clinical guideline publications, supplemented by supporting literature. No systematic literature search or meta-analysis was conducted. Results: Immediate management focuses on protecting the patient from further cold exposure, treating hypothermia, and rapidly rewarming affected areas in a warm water bath (37–39°C), followed by sterile wound care, possible blister management, splinting (immobilisation) and rapid hospital transport. Ibuprofen is recommended early for its anti-inflammatory and antiplatelet effects. In hospital settings, treatment includes rapid rewarming (if not yet applied), sterile wound care, analgesia, hydration, and tetanus prophylaxis. Thrombolytic therapy with rt-PA within 24 hours of rewarming may reduce amputation rates in deep frostbite. Iloprost is recommended as first-line therapy for grade 3–4 injuries, particularly when thrombolysis is contraindicated. Antibiotics are reserved for confirmed infection. Conclusions: Frostbite results from prolonged cold exposure, causing ice crystal formation, microvascular injury, inflammation, and ischemia. Early recognition and rapid, controlled rewarming, pain management, and immobilization are essential. Hospital care includes severity assessment, pharmacologic therapy (ibuprofen, thrombolytics, iloprost, anticoagulants), selective blister management, and supportive measures. Timely intervention reduces tissue loss, prevents progression to necrosis, and improves functional outcomes.