The pathologic changes resulting from freezing and nonfreezing cold injuries are identical, although generally more tissue is involved in the nonfreezing injuries, such as trench foot or immersion foot. In addition, maceration of the skin of the affected part is commonly observed in the nonfreezing entities. These are to be considered as caused by the effects of moisture, and not as the result of cold. The various tissues of the body do not show the same degree of susceptibility to cold injury. Nerves and striated muscle are highly susceptible; skin, fascia, and connective tissue are quite resistant, but not as resistant as compact bone or tendon. Blood vessels are highly susceptible to injury, resulting in leakage of plasma into the surrounding tissue. Necrosis as a rule does not occur in blood vessels as a result of cold. This relative tissue susceptibility has resulted in the observation of muscle gangrene without
FOUNTAIN EB. Mechanisms and Management of Cold Injury. AMA Arch Surg. 1957;75(5):716–717. doi:10.1001/archsurg.1957.01280170026013
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