Introduction and objective:
Frostbite is a severe cold-induced injury with significant risk of amputation and long-term disability. Existing literature on frostbite management is dominated by isolated case reports, with limited guidance on treatment tailored to injury severity. The aim of this article is to review the current state of knowledge regarding the pathophysiology, diagnostic approaches, and therapeutic strategies for frostbite, with particular attention to methods of surgical reconstruction, and to illustrate selected clinical scenarios from two Polish centres.

Review methods:
A comprehensive search of PubMed was performed up to December 2024 with no language restrictions, using the terms ‘frostbite’ combined with ‘microsurgery’, ‘free flaps’, and ‘epidermal substitute’. Additionally, data were retrospectively collected from the Hospital Information System (HIS) for patients with frostbite treated between January 2021 – December 2024 at the Burn Centre and the Department of Plastic and Reconstructive Surgery and Microsurgery, Poland.

Brief description of the state of knowledge:
Frostbite management includes rapid rewarming, wound care, pharmacologic interventions, and surgical procedures, depending on the depth of injury. For superficial injuries, epidermal substitutes such as Suprathel® can accelerate healing and reduce pain. Literature on reconstructive techniques in frostbite remains scarce, but evidence suggests that free tissue transfer, especially in weight-bearing areas, can preserve limb function and improve prosthetic adaptation.

Summary:
The literature review confirms a lack of comprehensive, severity-based treatment guidelines for frostbite. Clinical experience and literature support the use of epidermal substitutes for third-degree frostbite and microsurgical reconstruction for fourth-degree frostbite to optimize functional outcomes.