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Indications for early amputation include Wet gangrene Liquefaction Overwhelming infection Spreading sepsis Imaging can help determine when this is necessary Tissue care Goal is to maintain and restore good quality tissue after healing Attention should be paid to loadbearing and functionally significant areas There are no evidence based guidelines for management Secondary intention is likely the best course of action Topical negative pressure facilitates wound healing [31] Surgical flap is an alternative to secondary intention Especially in areas significant areas (hands, feet, poor vascular bed) Potential Adjunctive Therapies Hyperbaric oxygen therapy Sympathectomy Sympathectomy blocks the nerve, resulting in reflex vasodilation and increased blood flow [34] This can be surgical or chemical It is not currently recommended in acute frostbite management due to mixed results However, in chronic complications including vasopspasm, hyperhidrosis, it may have benefit Topical agents Aloe vera is accepted as the best practices baesd on the available evidence Further investigation into the following should be considered Poly-l-arginine contained in lotion Ganoderma triterpenids Nanogel delivery method Rehab and Return to Play Rehabilitation Variable, depends on affected area(s) Goal: return the individual to the optimal function and independence

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