Level of Cutaneous Blood Flow Depression during Cryotherapy Depends on Applied Temperature: Criteria for Protocol Design

[+] Author and Article Information
Sepideh Khoshnevis

Department of Biomedical Engineering, The University of Texas at Austin, 107 W. Dean Keeton Street, Stop C0800, Austin, Texas 78712

R. Matthew Brothers

Department of Kinesiology, University of Texas at Arlington, MAC 114, Arlington, TX 78229

Dr. Kenneth R. Diller

Fellow ASME, Department of Biomedical Engineering, The University of Texas at Austin, 107 W. Dean Keeton Street, Stop C0800, Austin, TX 78712

1Corresponding author.

ASME doi:10.1115/1.4041463 History: Received April 24, 2018; Revised September 06, 2018


Cryotherapy is commonly used for the management of soft tissue injury. The dose effect of the applied cooling temperature has not been quantified previously. Six subjects were exposed during five different experiments to local skin temperatures of 16C, 19C, 24C, 27C and 37C for 1 hour of active heat transfer followed by 2 hours of passive environmental interaction. Skin blood perfusion and temperature were measured continuously at treatment and control sites. All treatments resulted in significant changes in cutaneous vascular conductance (CVC) compared to baseline values. The drop in CVC for cooling to both 19C and 16C was significantly larger than for 27C (P<0.05 and P<0.0005, respectively). The depression of CVC for cooling to 16C was significantly larger than at 24C . Active warming at 37C produced more than a two-fold increase in CVC (P<0.05). A simulation model was developed to describe the coupled effects of exposure time and temperature on skin perfusion. The model was applied to define an equivalent cooling dose defined by exposure time and temperature that produced equivalent changes in skin perfusion. The model was verified with data from 22 independent cryotherapy experiments. The equivalent doses were applied to develop a nomogram to identify therapeutic time and temperature combinations that would produce a targeted vascular response. The nomogram may be applied to design cryotherapy protocols that will yield a desired vascular response history that may combine the benefits of tissue temperature reduction while diminishing the risk of collateral ischemic injury.

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