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Research Papers

Cryotherapy-Induced Persistent Vasoconstriction After Cutaneous Cooling: Hysteresis Between Skin Temperature and Blood Perfusion

[+] Author and Article Information
Sepideh Khoshnevis

Bioheat Transfer Laboratory,
Biomedical Engineering Department,
The University of Texas at Austin,
Austin, TX 78712
e-mail: Sepideh@utexas.edu

Natalie K. Craik, Kenneth R. Diller

Bioheat Transfer Laboratory,
Biomedical Engineering Department,
The University of Texas at Austin,
Austin, TX 78712

R. Matthew Brothers

Environmental and Autonomic
Physiology Laboratory,
Department of Kinesiology and
Health Education,
The University of Texas at Austin,
Austin, TX 78712

1Corresponding author.

2Current affiliation: Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030.

3Current affiliation: Associate Professor, Department of Kinesiology, University of Texas at Arlington, 701 S Nedderman Dr, Arlington, TX 76019.

Manuscript received September 2, 2015; final manuscript received November 20, 2015; published online January 29, 2016. Assoc. Editor: Ram Devireddy.

J Biomech Eng 138(3), 031004 (Jan 29, 2016) (8 pages) Paper No: BIO-15-1438; doi: 10.1115/1.4032126 History: Received September 02, 2015; Revised November 20, 2015

The goal of this study was to investigate the persistence of cold-induced vasoconstriction following cessation of active skin-surface cooling. This study demonstrates a hysteresis effect that develops between skin temperature and blood perfusion during the cooling and subsequent rewarming period. An Arctic Ice cryotherapy unit (CTU) was applied to the knee region of six healthy subjects for 60 min of active cooling followed by 120 min of passive rewarming. Multiple laser Doppler flowmetry perfusion probes were used to measure skin blood flow (expressed as cutaneous vascular conductance (CVC)). Skin surface cooling produced a significant reduction in CVC (P < 0.001) that persisted throughout the duration of the rewarming period. In addition, there was a hysteresis effect between CVC and skin temperature during the cooling and subsequent rewarming cycle (P < 0.01). Mixed model regression (MMR) showed a significant difference in the slopes of the CVC–skin temperature curves during cooling and rewarming (P < 0.001). Piecewise regression was used to investigate the temperature thresholds for acceleration of CVC during the cooling and rewarming periods. The two thresholds were shown to be significantly different (P = 0.003). The results show that localized cooling causes significant vasoconstriction that continues beyond the active cooling period despite skin temperatures returning toward baseline values. The significant and persistent reduction in skin perfusion may contribute to nonfreezing cold injury (NFCI) associated with cryotherapy.

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Figures

Grahic Jump Location
Fig. 1

Application of instrumentation at a measurement site. P1, P2, and P3 are the three perfusion probes. T shows the locations of thermocouples. This site will be covered with the cooling pad.

Grahic Jump Location
Fig. 2

(a) Percent change compared to baseline values for CVC (top panel) and skin temperature (bottom panel) for a sample experiment. The protocol followed 30 min of baseline, 60 min of active cooling, and 2 hrs of passive rewarming. (b) Percent change in CVC from baseline from a control experiment. The duration of active water flow through the cooling pad is marked on the plot.

Grahic Jump Location
Fig. 3

Temperature (top panel) and absolute CVC (bottom panel) values during the last 5 min of baseline and cooling (marked as B and C, respectively) and at the end of 10-min intervals during rewarming period. The values are average measurements from six different experiments. Error bars show the standard errors of the mean. The cooling process lasted for 60 min.

Grahic Jump Location
Fig. 4

Skin perfusion as a function of skin temperature during cooling (stars) and passive rewarming (dots). The arrows show the process direction. Each two subsequent data points are separated by 1 min. (a) Hysteresis plot from a single experiment. (b) The hysteresis plot based on the average measurements from six experiments.

Grahic Jump Location
Fig. 5

Simulation of transient temperature at incremental tissue depths during cooling and rewarming. The dark solid graph depicts the applied surface skin temperature (Ts). The initial spatial temperature gradient was calculated for steady-state conditions prior to the start of cooling.

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