Figure 11d.

Third-degree frostbite of the right foot and fourth-degree frostbite of the left foot in a 39-year-old man. (a) Plantar photographs obtained after blister aspiration and débridement show large areas of freshly débrided tissue involving the toes and plantar surfaces of both feet. (b–d) Multiphase ^99mTc-MDP bone scintigraphic images show an absence of tracer uptake in the distal left foot in the plantar blood flow phase at 100 seconds (with toe markers) (b), soft-tissue phase (with toe markers) (c), and 6-hour delayed phase (without markers) (d). (e) Fused SPECT/CT image clearly demonstrates the level of tracer cutoff at the metatarsophalangeal joints in the left second through fifth toes. The patient underwent amputation of the left second through fifth toes but was unwilling to have his left first toe removed at that time. (f) Repeat fused SPECT/CT image obtained 8 days later shows absent tracer uptake within the left first toe (arrowhead) at the identical level to that seen at previous SPECT/CT.