Frostbite is a cold-related injury resulting from prolonged exposure to subfreezing temperatures. The pathogenesis of frostbite is based on local ischaemia, cellular injury and destruction caused by ice formation and damage resulting from reperfusion after rewarming. Clinical examination and radiologic studies can help to determine the extent of tissue involvement, response to therapy and long-term tissue viability. The current standard of care for severe frostbite is rapid rewarming with adequate analgesia. Thrombolytics dissolve clots in the microvessels, thus improving perfusion to compromised areas. Vasodilators may prevent platelet aggregation and microvascular occlusion that occur after frostbite. Awareness of the pathogenesis of frostbite, new solutions for diagnostics and treatment make it possible to carry out treatment in a more successful way and help prevent amputations.