Ice Packs and Skin Perfusion

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The simple ice pack - a staple in both human and veterinary medicine for reducing pain and swelling. But what if this common therapy has unexpected consequences for healing? Soft tissue surgeon Dr. Vanna Dickerson and veterinary student Gabriella Hansen join us to discuss their fascinating research on how ice packs affect blood flow in canine skin.

For years, surgeons have cautioned against using ice after delicate skin procedures like flaps and grafts, believing it might compromise blood flow. However, this advice lacked scientific backing until now. Through precise measurements using laser speckle contrast imaging, Dr. Dickerson and Hansen discovered that ice application reduces skin perfusion by 10-15% compared to baseline - and surprisingly, in some dogs, blood flow remained decreased even 15 minutes after the ice was removed.

This groundbreaking work confirms what many surgeons suspected but couldn't prove, giving veterinarians evidence-based guidance for post-operative care decisions. Dr. Dickerson and Hansen emphasize that ice remains valuable for pain control in most situations, but surgeons should exercise caution in cases where even small perfusion decreases could jeopardize healing. For pet owners, understanding these nuances helps explain why your veterinarian might specifically recommend for or against icing in different scenarios.

Beyond the clinical findings, Dr. Dickerson and Hansen offer valuable insights for veterinary students interested in research, encouraging them to find mentors and emphasizing that meaningful studies don't require complex laboratory setups. Their work exemplifies how asking simple questions about everyday practices can lead to significant improvements in patient care. Listen now to discover how this common therapy affects your pet's healing and what questions still remain for future investigation.

AJVR article: https://doi.org/10.2460/ajvr.25.01.0023

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Episode Transcript

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Sarah Wright (00:35):
You're listening to Veterinary Vertex, a podcast
of the AVMA Journals.
In this episode, we chat abouthow the application of an ice
pack to healthy canine skindecreases skin perfusion, with
our guests Vanna Dickerson andGabriella Hansen.

Lisa Fortier (00:51):
Welcome listeners.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Today we have Vanna andGabriella joining us to talk
about what might seem like alow-hanging fruit, like you
would think, oh, ice pack.
But you know, some of thesethings are eminence-based and
not evidence.
So, Vanna and Gabriella, thankyou for putting some evidence
behind this commonly usedapplication and thank you for

(01:11):
being here.
Yeah, thanks for having us.

Sarah Wright (01:14):
Thank, you All right, let's dive right in.
So, Vanna, your AJVR articlediscusses the impact on skin
perfusion of ice packapplication on healthy skin.
Please share with our listenersthe background on this article.

Vanna Dickerson (01:27):
Yeah, so I'm a soft tissue surgeon, so I of
course have an interest inanything that has to do with
wound healing, but especially ifwe're going to do an advanced
procedure like a skin flap orskin graft.
And I was always told as aresident you know, don't ice
after those procedures becausewe're worried about decreasing
perfusion.
But you know, as Lisa mentioned, it's not something that I've

(01:50):
ever been able to find anyevidence to back up, and so I
thought this could be a you know, kind of a great project for
someone like Gabriella to helptake on.

Sarah Wright (01:58):
So yeah, I was taught similarly even as a
veterinary student not too toolong ago, so always nice to see
evidence behind differentrecommendations.
Sometimes, too, can change ourthinking about things.
So with that in mind, where'ssome of the foreign take-home
messages from this article?

Vanna Dickerson (02:13):
Yeah, I think so.
We did find a defreeze in skinperfusion by with this technique
, which I'm sure we'll talk alittle bit about as we move
forward.
But it is important to compareto a baseline.
So when comparing to what theirperfusion was prior to any
icing, we saw a decrease byabout 10 to 15 percent,
depending on the time we werelooking at it.

(02:34):
So I think that was reallyinteresting.
We expected to see a decrease,just weren't sure by how much,
and I think at this point westill have a lot of questions to
answer how much?
And I think at this point westill have a lot of questions to
answer.
But my take home as of rightnow is I probably will continue
to avoid icing after, especiallyprocedures where a little bit
of decrease in perfusion couldmean the flap fails or something

(02:55):
like that.

Lisa Fortier (02:57):
Yeah, really important for wound healing.
Thank you for again puttingsome evidence behind this,
gabriella.
What sparked your interest inskin perfusion and ice pack
application?

Gabriella Hansen (03:06):
Yes, so I am a current veterinary student at
Texas A&M.
Right now I'm a third year andthey have this really awesome
program that they offer to firstand second year veterinary
students, called the VMSRT orthe Veterinary Medical Student
Research Training Program.
So I had always been wanting toget involved in research, and

(03:26):
what was special about thisspecific program is that they
allowed for the veterinarystudents to get involved in any
research or area of veterinarymedical research that they
wanted to, under the guidance ofa mentor that they chose.
So this was like the perfectopportunity for me to finally
start getting involved inclinical research, and I've
always been fascinated withwound care and surgery.

(03:47):
So I quickly asked Vanna to bemy specific mentor and do a
project with me.
And, just like she hadmentioned before, commonly after
surgery we often put ice tohelp with like healing and like
decreasing swelling and for allthe perceived benefits, yet I
wasn't sure if icing had anyeffects on perfusion.
So I thought it was a reallycool time to start exploring

(04:10):
that Fantastic.

Lisa Fortier (04:11):
I'll be at Texas A&M this June.
Noah Cohn's hosting me to comeand give our my editorial talk.
I think it's called how to Getyour Work Published and Noticed
through the Lens of anEditor-in-Chief, so I hope to
meet both of you.
In 3D, earlier Vanna talkedabout the biggest take-home
message, but every time we do aninvestigation there's something
that surprises us, and maybefor Vanna it was like how much

(04:33):
it decreased.
What surprised you from thisarticle?

Gabriella Hansen (04:36):
Yes, so it was surprising to see that the
perfusion values in some dogswere decreased 15 minutes
post-icing compared toimmediately post-icing.
There are many factors at playthat could have contributed to
this that we still need toexplore, such as individual dogs
, breed, the skin thickness, age, skin pigmentation, etc.

(04:56):
So there is a need for morestudies to further evaluate the
relationship between theindividual dogs factors and skin
perfusion.

Lisa Fortier (05:05):
I would think a big factor would be sub-Q fat,
right?
Do you think that subjectively,without having measured the
thickness of sub-Q fat, like Iwould think they would cool
faster if they had a lot of fatrather than muscle?
Yes, I would definitely thinkso.

Sarah Wright (05:20):
So, this actually is net perfectly into our next
question what are the next stepsfor research in this topic?

Gabriella Hansen (05:28):
We do need some larger studies with more
groups of dogs with surgical ornaturally traumatized skin to
see the clinical impact of icingon skin perfusion.
Furthermore, mean specklecontrast values are compared to
the individual dog's baseline todetermine these perfusion
changes.
So it's difficult to see ifthere's a specific mean speckle

(05:51):
contrast value that contributesto a clinical significant
decrease in skin perfusion thatcan be applied to like a wide
variety and population of dogsat once.
So yeah, we just need to keep,you know, enrolling dogs,
measuring their skin perfusion,everything with icing and
determine if there's a specificpercentage of decrease in

(06:13):
perfusion that correlates withdelayed healing.

Sarah Wright (06:15):
Sounds like a great future project, and do you
see AI in this area of research?

Gabriella Hansen (06:21):
So as a veterinary student, I'm not
completely sure on the role ofAI within clinical research as a
whole, but there could be arole for AI within this specific
project.
A lot of our image analysis wasthrough image J, so I believe
that AI could standardize thenumber of pixels and the area of
pixels that we use to calculatethe mean speckle contrast.
So I definitely see there couldbe a role for AI within this

(06:44):
project.

Sarah Wright (06:45):
Yeah, and we're actually compiling all of our
answers about AI and Cornell'shaving this really cool
symposium on artificialintelligence shortly, which Lisa
will be presenting at, which isreally awesome, and we're going
to be sharing the answers fromthe podcast.
People answer that question.
So if anyone's looking for AIin veterinary clinical medicine
research, be sure to reach outto Vanna and Gabriella for the

(07:07):
specific topic.
And for those of you justjoining us, we're discussing how
the application of an ice packto healthy canine skin decreases
skin perfusion with our guestsVanna and Gabriella.

Lisa Fortier (07:17):
Vanna, you're quite a prolific author and
obviously a great mentor.
How did your training andprevious work help you to get
the idea for this study?
Get it through, get Gabriellethrough it while she's studying
as well.
It's really hard to get thisdone as a student.
So well done Gabrielle andVanna.
And what advice do you have forother mentors or students who

(07:41):
are trying to get published?

Vanna Dickerson (07:43):
Yeah, I think you know I was really fortunate
to do a research fellowship fortwo years.
So that's almost all I did wasresearch with research animals
before my residency.
So I did have a lot of helpthrough my master's that I did
with that in terms of kind oflearning about scientific

(08:03):
writing and statistics and allthose things.
I think that helped me a lot.
But really, yeah, I have areally strong passion for
helping these young students,interns, residents, kind of get
their first thing published.
There's such a sense ofaccomplishment with it.
So that's really a lot of myfocus is kind of looking for
projects that I can kind of helpsomeone that's starting out

(08:26):
through.
That first piece of advice wouldjust be to realize that
research can mean a lot ofthings.
I think sometimes people hearthe word oh, I'm going to have
to do a research project if Iwant to do an internship or
residency or something like that, and immediately think of being
stuck in a lab, which can befun.
I've done that too.
But you know it can mean a lotof things and if you have

(08:50):
someone to help you through theprocess really can be quite fun.
So I think that's helpful.
I think it's helped me biginterest in wound healing
obviously and this is one ofthree studies we've published so

(09:15):
far with the laser specklecontrast imaging.
So I think the more we publishwith it too just makes it a
smoother process to get through.

Lisa Fortier (09:23):
Yeah, that's fantastic.
Gabriella, do you have anythingto add to encourage other
students to dabble into writingup their research projects?

Gabriella Hansen (09:32):
I think the first piece of advice that comes
to my mind is definitely reachout If you're interested in
research.
I'm sure that there's someonewho's willing to like take them
under their wing and help getthem started.
I was really scared when I wasgoing to do this research
program with Vanna.
Nothing against Vanna, I wasjust scared about my own
capabilities because I'd neverdone research before, or not

(09:53):
like on this scale.
So definitely like finding agood mentor, just reaching out.
I would say definitely do thatto help get you started in
research and don't be scared.

Sarah Wright (10:04):
I think that's great advice.
I was giving a talk at theSabma Symposium in Davis in
March and part of it was justabout, like, my career path and
how I got into scholarlypublishing, and a lot of that
was because I was publishing asa student, intern etc.
And students asked meafterwards they're like well,
how do you, how do you like, getsomeone interested in helping
you get the project going.
So I think that's really greatadvice, gabriella, and hopefully
that helps our listeners onthis podcast too, who might be

(10:26):
interested in pursuing yourprojects.
Now Van's next set of questions, as you know, is going to be
really important for ourlisteners, and the first one is
going to be about theveterinarian's perspective.
What is one piece ofinformation the veterinarian
should know about the impact onskin perfusion of ice pack
application on healthy skin?

Vanna Dickerson (10:53):
lot of work to do in terms of trying to figure
out how this might impact aspecific dog, based on their age
, how you know their habitus,how thick it is, that sort of
thing.
But I think this is at leastenough evidence to cause me to
have pause with using icing ifI've done something like a flap
or a graft, or even if it's ayou know, a skin incision in an
animal that you think isotherwise really compromised,
has Cushing's or something likethat.
So to me this is enough tocause pause with that.

(11:16):
I think it doesn't mean that weshouldn't be icing incisions.
I think we certainly don't haveevidence that it's going to
make all incisions have aproblem and we have a lot of
evidence to support its use inpain control and inflammation
control.
So certainly wouldn't make mestop icing things.
Just kind of thinking about thespecific situation.

Sarah Wright (11:35):
And on the other side of the relationship, what's
one thing the client shouldthink about regarding this topic
.

Vanna Dickerson (11:39):
Yeah, I think you know similar.
You know, don't be afraid oficing.
We've all had an injury and weknow that icing can make it feel
a lot better.
So I do think that if your petwill tolerate it and they've had
a surgery and your veterinarianthinks it's okay, please ice
their incisions.
But you know, just if yourveterinarian tells you not to

(12:00):
ice it, there may be a reasonbehind it.

Lisa Fortier (12:01):
So good old situational awareness.
Yeah Well, thank you again forboth of you for being here and,
as we wind down, we like to aska little bit more of a personal
or a fun question.
So, gabriella, for you and ifyou have it, you feel free to
share it on your video what'sthe oldest or most interesting
item on your desk or in yourdesk drawer?

Gabriella Hansen (12:24):
So I don't have it right now because I'm at
my parents' house, but in mycollege apartment on my desk I
have in a frame I have theoriginal Time magazine from 1969
about the moon landing.
That's my prized possession.
It's been passed down within myfamily, so yeah, it's pretty
cool.

Lisa Fortier (12:43):
That's super cool.
That's really super cool.
Vanna, as a surgeon, I think Ican probably guess this, but you
never know.
When you complete a puzzle, doyou begin with the border
exterior pieces or the middleinterior?

Vanna Dickerson (12:57):
Yeah, I chose this one because you know, I got
to know like what people'sanswers have been with you guys,
but it's the exterior for sureall the way.
It's the only way, I think.
But since hearing this questionon past podcasts with y'all,
I've asked some people and youknow that's not everyone's
answer.

Lisa Fortier (13:15):
But then sometimes , if you dig in so that is our
observation that surgeons aremore exterior.
I mean, if you want to broadlydefine people or split them into
surgeons or medicine andmedicine start more in the
interior.
But then sometimes you getsomebody who's like well, I
really wanted to do surgery butmy career path did this and
you're like aha, so that's whyyou do border.
But I would say for the mostpart surgeons are border folks,

(13:39):
like it's the only way, likedon't mess with my puzzle.

Sarah Wright (13:44):
Maybe that can be our next spreadsheet.
We'll compile like intervieweeand then like what their answer
is and we'll actually look tosee if there's some evidence
behind.
Yeah, you should compare it totheir Hogwarts house answer is
and we'll actually look to see,see if there's some evidence
behind.

Vanna Dickerson (13:53):
Yeah, you should compare it to their
hogwarts house exactly actually.

Sarah Wright (13:57):
Yeah, funny enough , we just I'm having my, our
team do the hogwarts sortinghack quiz, because we've just
been talking about harry pottera lot recently, so I've
convinced three of our copyeditors to do it.
They're all slithering so far,which I feel like makes sense to
me, because they're really likefocused, detail-oriented, you
know, like head-to-the-groundpeople For sure.
That's been fun.
Just thank you both again forbeing here today.

(14:19):
We appreciate your time andalso for submitting your
manuscript, too, to AJVR.
Yeah, thank you guys.
Thank you so much.
And to our listeners you canread Vanna and Gabriella's
article in AJVR.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.