The patient should be encouraged to take a nutritious diet with adequate fluids to maintain hydration. Patients should be placed on surgically clean sheets and all lesions should be exposed to the air at the normal room temperature. Superficial debridement of ruptured blebs should be performed, and suppurative eschars and partially detached nails should be removed. Close attention should be paid to circumferential eschars or eschars where vascular compromise could be a problem. Such eschars at least should be bivalved, although complete debridement is occasionally necessary.
Early amputation has no place in the management of cold injury.
Surgical intervention should be deferred until a distinct line of demarcation has developed. There is usually healthy granulation tissue under an eschar at the line of demarcation. Delay of surgical procedures, especially in upper extremity injuries, will enhance the potential for a functional result. Rarely, generalized sepsis from large areas of necrotic and infected tissue will necessitate amputation. Skin grafting, while not a function of forward facilities, is occasionally indicated to protect denuded areas over vital structures.