Fewer amputations in Yukon, thanks to pioneering frostbite treatment

Frostbite treatment in Yukon has seen “dramatic change” in the last few years, according to a local surgeon who helped pioneer a new approach for Canadian hospitals.

Dr. Alex Poole, who works at Whitehorse General Hospital, says the change can be seen in the operating room where there have been fewer amputations.

“Over five years now, we’ve had 22 patients that we’ve treated with this [treatment] protocol, aggressively,” Poole said.

“We grade frostbite from one to four — four being the worst, which we would expect a 100 per cent amputation rate. We’ve got that down to 50 [per cent]. And we’ve not had to have any amputations on our grade twos and threes.”

Poole and his collaborator, pharmacist Josianne Gauthier, first gained national attention a few years ago when they began having success with a new approach to treating severe frostbite. 

They were using a drug called Iloprost, which is typically used for a variety of diseases but is not commercially available in Canada. Used for frostbite, Poole and Gauthier found it can prevent tissue from dying and help it heal. Sometimes they’ve used it in combination with thrombolytics, which are used for blood clots.

“[Iloprost] opens up the blood vessels and restores the blood flow to the extremities. So it helps prevent amputation,” Gauthier said.

The Whitehorse treatment protocol for frostbite involves a vasodilator that opens blood vessels and restores circulation to the extremities. It can save digits and limbs from amputation, the researchers have found. (Bruce Tilley/CBC)

Poole says it all started a few years ago when they wanted to find the most up-to-date treatments for frostbite. The hospital typically sees two or three cases of severe frostbite each year, Poole said.

“When you go to meetings in the south and you tell them that you’re a surgeon in the Yukon, people assume that you’re good at looking at the cold injuries,” he said.

They started doing their research and talking to experts around the world.

“This brought us down the path of what we now have — likely a state-of-the-art, for us, frostbite protocol,” he said.

Research ‘lit a fire across the country’ 

The two published an article a few years ago in the Canadian Medical Association Journal (CMAJ) describing their approach and were surprised when it “lit a fire across the country,” Poole said.

“It turns out we weren’t the only ones that needed to modernize our frostbite care, across not just northern Canada, but some of the southern cities that get cold temperatures, like Calgary and Edmonton,” he said.

“So that’s been very satisfying with our work so far, is that we sort of had an influence across the entire country for frostbite care, hopefully saving some fingers and toes along the way.”

Poole and Gauthier continue to gain attention for their work. Another of their papers will soon be published in the CMAJ.

They’re also continuing their research, looking to further refine their treatment protocol and save more digits and limbs.

“The more time we spend researching … the more questions we have,” Poole said.

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