Frostbite injuries related to recreational nitrous oxide use: incidence, management, and complications in a Swedish case series

Background: Nitrous oxide (N2O) use in recreational settings has been increasing in Sweden and Europe and consequently, the related injuries are also increasing. We aimed to investigate the incidence, management, and surgical outcomes of frostbite injury (FI) related to N2O use. Material and Method: All patients in a 22-month period from 2021 to 2022 presenting with FI related to N2O abuse from 2 plastic surgery clinics (1 national burn center) were identified. Data regarding patient comorbidity, mechanism of injury, initial management, treatment, and follow-up were investigated. Complications following surgery were categorized into minor (treated in outpatient setting) and major (requiring reoperation) complications. Results: In total, 9 patients were identified; among them, 5 patients provided consent and were included in the study. Direct contact with the gas canister was the most common injury mechanism (n = 4). All but 1 patient contracted full-thickness injuries, and these 4 patients later required surgery. The medial thigh was the most common area of injury. Outpatient clinic visits were common (mean 4.8 visits/patient). Surgical complications were common and all operated patients were diagnosed with minor complications and half of them with major complications (wound dehiscence and scar contracture). Conclusion: Frostbite injuries arising from recreational N2O use are complex and often require surgical intervention that may lead to complications. With the increasing incidence of N2O abuse in Sweden, further research is crucial to address this emerging public health concerns and optimize treatment strategies for these dis- tinctive injuries.