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Cold-induced vasoconstriction may persist long after cooling ends: an evaluation of multiple cryotherapy units

Abstract

Purpose

Localized cooling is widely used in treating soft tissue injuries by modulating swelling, pain, and inflammation. One of the primary outcomes of localized cooling is vasoconstriction within the underlying skin. It is thought that in some instances, cryotherapy may be causative of tissue necrosis and neuropathy via cold-induced ischaemia leading to nonfreezing cold injury (NFCI). The purpose of this study is to quantify the magnitude and persistence of vasoconstriction associated with cryotherapy.

Methods

Data are presented from testing with four different FDA approved cryotherapy devices. Blood perfusion and skin temperature were measured at multiple anatomical sites during baseline, active cooling, and passive rewarming periods.

Results

Local cutaneous blood perfusion was depressed in response to cooling the skin surface with all devices, including the DonJoy (DJO, p = 2.6 × 10−8), Polar Care 300 (PC300, p = 1.1 × 10−3), Polar Care 500 Lite (PC500L, p = 0.010), and DeRoyal T505 (DR505, p = 0.016). During the rewarming period, parasitic heat gain from the underlying tissues and the environment resulted in increased temperatures of the skin and pad for all devices, but blood perfusion did not change significantly, DJO (n.s.), PC300 (n.s.), PC500L (n.s.), and DR505 (n.s.).

Conclusions

The results demonstrate that cryotherapy can create a deep state of vasoconstriction in the local area of treatment. In the absence of independent stimulation, the condition of reduced blood flow persists long after cooling is stopped and local temperatures have rewarmed towards the normal range, indicating that the maintenance of vasoconstriction is not directly dependent on the continuing existence of a cold state. The depressed blood flow may dispose tissue to NFCI.

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Acknowledgments

This research was sponsored by National Science Foundation Grants CBET 0828131, CBET 096998, and CBET 1250659, National Institutes of Health Grant R01 EB015522, and the Robert and Prudie Leibrock Professorship in Engineering at the University of Texas at Austin. We would also like to thank Ms. Natalia Mejia for investing long hours of careful and conscientious work in her critical role in extracting data for this publication, and Dr. Michael Mahometa of the Division of Statistics and Scientific Computation, College of Natural Sciences at the University of Texas at Austin for his help and guidance in statistical analysis of data. Comments by the reviewers have been very helpful.

Conflict of interest

A patent application has been submitted by Dr. Khoshnevis and Dr. Diller to the United States Patent and Trademark Office under the title Improved Cryotherapy Devices and Methods to Limit Ischaemic Injury Side Effects. Ownership rights to this patent reside with The University of Texas System. Dr. Diller has served as an expert witness for both plaintiff and defendant counsel since 2000 in numerous legal cases regarding the safety and design of existing cryotherapy devices.

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Correspondence to Kenneth R. Diller.

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Khoshnevis, S., Craik, N.K. & Diller, K.R. Cold-induced vasoconstriction may persist long after cooling ends: an evaluation of multiple cryotherapy units. Knee Surg Sports Traumatol Arthrosc 23, 2475–2483 (2015). https://doi.org/10.1007/s00167-014-2911-y

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Keywords

  • Cryotherapy
  • Vasoconstriction
  • Tissue blood perfusion
  • Tissue cooling
  • Nonfreezing cold injury