Early surgical debridement of frostbite injuries is nearly always contraindicated, as the reversibility and progression of the frostbite injury cannot be quantied in the early stages. Debridement is best delayed until denitive demarcation of devi­talised tissues at approximately 6–8weeks post­injury. With appropriate management, surgery is frequently not required, despite the initial appear­ance of the injury. Similarly, it may be appropri­ate to leave demarked areas to auto-amputate if expert surgical input is not available or if the patient has substantial comorbidities making anaesthesia unsafe. Exceptions to this conserva­tive approach to surgery include injuries with uncontrolled severe infection, concurrent severe limb trauma and compartment syndrome, all of which may require urgent limb surgery. Fortunately, these are infrequent and are more commonly seen in freeze-thaw-refreeze injuries (Table13.4).