Application of Ice for Postoperative Total Knee Incisions – Does this Make Sense? A Pilot Evaluation of Blood Flow Using Fluorescence Angiography

Abstract

IntroductionTotal knee arthroplasty (TKA) is a common procedure with significant advances over the past several years, many pertaining to improved perioperative pain control. Cryotherapy is one method thought to decrease swelling and pain postoperatively. To our knowledge no study has directly visualized the effect cryotherapy has on skin blood flow following TKA. The primary aim was to determine if cryotherapy (icing) affects peri-incisional skin blood flow and if this is lessened with an alternate placement of the ice. We hypothesized that blood flow would decrease following cryotherapy, and this decrease would be greater with ice placed directly over the incision as compared to placement along the posterior knee.MethodsThis study included 10 patients who underwent TKA. During the postoperative hospitalization, they were given an injection of indocyanine green dye. A baseline image was recorded of the skin blood flow. Images were then collected following a five-minute interval placement of ice over the incision. The experiment was then repeated with the ice placed along the posterior knee. ResultsThere was an approximate 40% decrease in skin blood flow following placement of the ice compared to baseline. We observed a greater decrease in blood flow when ice was placed over the incision as compared to when ice was placed posterior to the knee (p ≤ 0.020).ConclusionWe found a significant decrease in peri-incisional blood flow with icing of the knee. Physicians should be cognizant of this when recommending cryotherapy to patients after surgery, especially in at-risk wounds.

Mirabilite with ice pack after Total Knee Arthroplasty: A Randomized Controlled Trial Study

“…Cryotherapy is a Non-pharmaceutical treatment to relief of postoperatively pain and swelling, which involves the application of cold to the skin surrounding the injured soft tissues and in joint surgery is supposed to reduce the temperature in knee-joint [7] . Low temperature will reduce local blood ow through vasoconstriction, which relieves the local in ammatory reaction, swelling and heat experience, and also will slow the conduction of nerve signals that potentially reducing pain transmission [10][11][12] . In addition, previous study has shown that a pleasant sensation evoked by knee icing also will reduce the pain intensity after TKA [13] .…”

Assessment of wound perfusion with near-infrared angiography: A prospective feasibility study

“…Indocyanine green and near-infrared angiography have been used to assess perfusion of skin flaps, wound closures, abdominoplasties, and bowel anastomoses ( Diep et al, 2016 , Duggal et al, 2014 , Mirhaidari et al, 2018 , Pruimboom et al, 2020;4:CD013280. , Wyles et al, 2016 , Patel et al, 2013 , Moukarzel et al, 2020 , Wilke et al, 2021 , Rinker, 2016 , Foster et al, 2019 , Shannon et al, 2017 ). Given its success in similar applications, we sought to investigate the feasibility of using near-infrared angiography to evaluate skin perfusion before and after suture- or staple-assisted laparotomy closure during gynecologic surgery.…”

A Prospective Evaluation of Intraoperative Indocyanine Green Fluorescence Angiography for Soft Tissue Sarcomas

“…Indocyanine green (ICG) angiography provides the surgeon this ability and has successfully been used in plastic surgery, general surgery, and more recently in orthopaedic surgery, to predict the survival of tissue and planned flaps. [10][11][12][13] We recently reported on ICG angiography use in sarcoma surgery, demonstrating that it was predictive of developing a postoperative wound complication, especially in the lower extremity. 14 What is unknown, however, is whether use of this technology will translate to lower postoperative wound complication rates.…”