Figure 6c.

Third-degree frostbite of the toes in a 22-year-old man. (a) Dorsal photographs show bilateral diffuse discoloration of the toes and hemorrhagic blisters. (b) DSA images obtained at presentation show absent perfusion beyond the distal interphalangeal joints bilaterally. (c) DSA images obtained after 24 hours of continuous intra-arterial tPA infusion via the popliteal arteries show near-complete resolution. (d–f) Multiphase technetium 99m (^99mTc) labeled–methylene diphosphonate (MDP) bone scintigraphic images of the feet obtained 1 month later because of persistent superficial wounds show preserved uptake throughout both feet in the plantar blood flow phase at 35 seconds (with toe and heel markers) (d), soft-tissue phase (without markers) (e), and 4.5-hour delayed phase (without markers) (f). Note the nonuniform uptake on the delayed phase image, with areas of increased uptake within the heels, medial midfeet, and first toes that correspond to areas of hyperemia on the blood flow and soft-tissue phase images. (g) Fused SPECT/CT image shows preserved tracer uptake throughout both feet. The patient made a full recovery without tissue loss or surgery.