Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Ice Packs and Skin Perfusion
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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Speaker 2:You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode, we chat about how the application of an ice pack to healthy canine skin decreases skin perfusion, with our guests Vanna Dickerson and Gabriella Hansen.
Speaker 3:Welcome listeners. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have Vanna and Gabriella joining us to talk about what might seem like a low-hanging fruit, like you would think, oh, ice pack. But you know, some of these things are eminence-based and not evidence. So, Vanna and Gabriella, thank you for putting some evidence behind this commonly used application and thank you for being here. Yeah, thanks for having us.
Speaker 2:Thank, you All right, let's dive right in. So, vanna, your AJVR article discusses the impact on skin perfusion of ice pack application on healthy skin. Please share with our listeners the background on this article.
Speaker 4:Yeah, so I'm a soft tissue surgeon, so I of course have an interest in anything that has to do with wound healing, but especially if we're going to do an advanced procedure like a skin flap or skin graft. And I was always told as a resident you know, don't ice after those procedures because we're worried about decreasing perfusion. But you know, as Lisa mentioned, it's not something that I've ever been able to find any evidence to back up, and so I thought this could be a you know, kind of a great project for someone like Gabriella to help take on.
Speaker 2:So yeah, I was taught similarly even as a veterinary student not too too long ago, so always nice to see evidence behind different recommendations. Sometimes, too, can change our thinking about things. So with that in mind, where's some of the foreign take-home messages from this article?
Speaker 4:Yeah, I think so. We did find a defreeze in skin perfusion by with this technique, which I'm sure we'll talk a little bit about as we move forward. But it is important to compare to a baseline. So when comparing to what their perfusion was prior to any icing, we saw a decrease by about 10 to 15 percent, depending on the time we were looking at it. So I think that was really interesting. We expected to see a decrease, just weren't sure by how much, and I think at this point we still have a lot of questions to answer how much? And I think at this point we still have a lot of questions to answer. But my take home as of right now is I probably will continue to avoid icing after, especially procedures where a little bit of decrease in perfusion could mean the flap fails or something like that.
Speaker 3:Yeah, really important for wound healing. Thank you for again putting some evidence behind this, gabriella. What sparked your interest in skin perfusion and ice pack application?
Speaker 5:Yes, so I am a current veterinary student at Texas A&M. Right now I'm a third year and they have this really awesome program that they offer to first and second year veterinary students, called the VMSRT or the Veterinary Medical Student Research Training Program. So I had always been wanting to get involved in research, and what was special about this specific program is that they allowed for the veterinary students to get involved in any research or area of veterinary medical research that they wanted to, under the guidance of a mentor that they chose. So this was like the perfect opportunity for me to finally start getting involved in clinical research, and I've always been fascinated with wound care and surgery. So I quickly asked Vanna to be my specific mentor and do a project with me. And, just like she had mentioned before, commonly after surgery we often put ice to help with like healing and like decreasing swelling and for all the perceived benefits, yet I wasn't sure if icing had any effects on perfusion. So I thought it was a really cool time to start exploring that Fantastic.
Speaker 3:I'll be at Texas A&M this June. Noah Cohn's hosting me to come and give our my editorial talk. I think it's called how to Get your Work Published and Noticed through the Lens of an Editor-in-Chief, so I hope to meet both of you. In 3D, earlier Vanna talked about the biggest take-home message, but every time we do an investigation there's something that surprises us, and maybe for Vanna it was like how much it decreased. What surprised you from this article?
Speaker 5:Yes, so it was surprising to see that the perfusion values in some dogs were decreased 15 minutes post-icing compared to immediately post-icing. There are many factors at play that could have contributed to this that we still need to explore, such as individual dogs, breed, the skin thickness, age, skin pigmentation, etc. So there is a need for more studies to further evaluate the relationship between the individual dogs factors and skin perfusion.
Speaker 3: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 I would think they would cool faster if they had a lot of fat rather than muscle? Yes, I would definitely think so.
Speaker 2:So this actually is net perfectly into our next question what are the next steps for research in this?
Speaker 5:topic. We do need some larger studies with more groups of dogs with surgical or naturally traumatized skin to see the clinical impact of icing on skin perfusion. Furthermore, mean speckle contrast values are compared to the individual dog's baseline to determine these perfusion changes. So it's difficult to see if there's a specific mean speckle contrast value that contributes to a clinical significant decrease in skin perfusion that can be applied to like a wide variety and population of dogs at 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 specific percentage of decrease in perfusion that correlates with delayed healing.
Speaker 2:Sounds like a great future project, and do you see AI in this area of research?
Speaker 5:So as a veterinary student, I'm not completely sure on the role of AI within clinical research as a whole, but there could be a role for AI within this specific project. A lot of our image analysis was through image J, so I believe that AI could standardize the number of pixels and the area of pixels that we use to calculate the mean speckle contrast. So I definitely see there could be a role for AI within this project.
Speaker 2:Yeah, and we're actually compiling all of our answers about AI and Cornell's having this really cool symposium on artificial intelligence shortly, which Lisa will be presenting at, which is really awesome, and we're going to be sharing the answers from the podcast. People answer that question. So if anyone's looking for AI in veterinary clinical medicine research, be sure to reach out to Vanna and Gabriella for the specific topic. And for those of you just joining us, we're discussing how the application of an ice pack to healthy canine skin decreases skin perfusion with our guests Vanna and Gabriella.
Speaker 3:Vanna, you're quite a prolific author and obviously a great mentor. How did your training and previous work help you to get the idea for this study? Get it through, get Gabrielle through it while she's studying as well. It's really hard to get this done as a student. So well done Gabrielle and Vanna. And what advice do you have for other mentors or students who are trying to get published?
Speaker 4:Yeah, I think you know I was really fortunate to do a research fellowship for two years. So that's almost all I did was research with research animals before my residency. So I did have a lot of help through my master's that I did with that in terms of kind of learning about scientific writing and statistics and all those things. I think that helped me a lot. But really, yeah, I have a really strong passion for helping these young students, interns, residents, kind of get their first thing published. There's such a sense of accomplishment with it. So that's really a lot of my focus is kind of looking for projects that I can kind of help someone that's starting out through.
Speaker 4:That first piece of advice would just be to realize that research can mean a lot of things. I think sometimes people hear the word oh, I'm going to have to do a research project if I want to do an internship or residency or something like that, and immediately think of being stuck in a lab, which can be fun. I've done that too. But you know it can mean a lot of things and if you have someone to help you through the process really can be quite fun. So I think that's helpful. I think it's helped me big interest in wound healing obviously and this is one of three studies we've published so far with the laser speckle contrast imaging. So I think the more we publish with it too just makes it a smoother process to get through.
Speaker 3:Yeah, that's fantastic. Gabriella, do you have anything to add to encourage other students to dabble into writing up their research projects?
Speaker 5:I think the first piece of advice that comes to my mind is definitely reach out If you're interested in research. I'm sure that there's someone who's willing to like take them under their wing and help get them started. I was really scared when I was going to do this research program with Vanna. Nothing against Vanna, I was just scared about my own capabilities because I'd never done research before, or not like on this scale. So definitely like finding a good mentor, just reaching out. I would say definitely do that to help get you started in research and don't be scared.
Speaker 2:I think that's great advice. I was giving a talk at the Sabma Symposium in Davis in March and part of it was just about, like, my career path and how I got into scholarly publishing, and a lot of that was because I was publishing as a student, intern etc. And students asked me afterwards they're like well, how do you, how do you like, get someone interested in helping you get the project going. So I think that's really great advice, gabriella, and hopefully that helps our listeners on this podcast too, who might be interested in pursuing your projects. Now Van's next set of questions, as you know, is going to be really important for our listeners, and the first one is going to be about the veterinarian's perspective. What is one piece of information the veterinarian should know about the impact on skin perfusion of ice pack application on healthy skin?
Speaker 4:lot of work to do in terms of trying to figure out how this might impact a specific dog, based on their age, how you know their habitus, how thick it is, that sort of thing. But I think this is at least enough evidence to cause me to have pause with using icing if I've done something like a flap or a graft, or even if it's a you know, a skin incision in an animal that you think is otherwise really compromised, has Cushing's or something like that. So to me this is enough to cause pause with that. I think it doesn't mean that we shouldn't be icing incisions. I think we certainly don't have evidence that it's going to make all incisions have a problem and we have a lot of evidence to support its use in pain control and inflammation control. So certainly wouldn't make me stop icing things. Just kind of thinking about the specific situation.
Speaker 2:And on the other side of the relationship, what's one thing the client should think about regarding this topic.
Speaker 4:Yeah, I think you know similar. You know, don't be afraid of icing. We've all had an injury and we know that icing can make it feel a lot better. So I do think that if your pet will tolerate it and they've had a surgery and your veterinarian thinks it's okay, please ice their incisions. But you know, just if your veterinarian tells you not to ice it, there may be a reason behind it.
Speaker 3:So good old situational awareness. Yeah Well, thank you again for both of you for being here and, as we wind down, we like to ask a little bit more of a personal or a fun question. So, gabriella, for you and if you have it, you feel free to share it on your video what's the oldest or most interesting item on your desk or in your desk drawer?
Speaker 5:So I don't have it right now because I'm at my parents' house, but in my college apartment on my desk I have in a frame I have the original Time magazine from 1969 about the moon landing. That's my prized possession. It's been passed down within my family, so yeah, it's pretty cool.
Speaker 3:That's super cool. That's really super cool. Vanna, as a surgeon, I think I can probably guess this, but you never know. When you complete a puzzle, do you begin with the border exterior pieces or the middle interior?
Speaker 4:Yeah, I chose this one because you know, I got to know like what people's answers have been with you guys, but it's the exterior for sure all the way. It's the only way, I think. But since hearing this question on past podcasts with y'all, I've asked some people and you know that's not everyone's answer.
Speaker 3:But then sometimes, if you dig in so that is our observation that surgeons are more exterior. I mean, if you want to broadly define people or split them into surgeons or medicine and medicine start more in the interior. But then sometimes you get somebody who's like well, I really wanted to do surgery but my career path did this and you're like aha, so that's why you do border. But I would say for the most part surgeons are border folks, like it's the only way, like don't mess with my puzzle.
Speaker 2:Maybe that can be our next spreadsheet. We'll compile like interviewee and then like what their answer is and we'll actually look to see if there's some evidence behind. Yeah, you should compare it to their Hogwarts house answer is and we'll actually look to see, see if there's some evidence behind.
Speaker 4:Yeah, you should compare it to their hogwarts house exactly actually.
Speaker 2:Yeah, funny enough, we just I'm having my, our team do the hogwarts sorting hack quiz, because we've just been talking about harry potter a lot recently, so I've convinced three of our copy editors to do it. They're all slithering so far, which I feel like makes sense to me, because they're really like focused, detail-oriented, you know, like head-to-the-ground people For sure.
Speaker 2:That's been fun. Just thank you both again for being here today. We appreciate your time and also for submitting your manuscript, too, to AJVR. Yeah, thank you guys. Thank you so much. And to our listeners you can read Vanna and Gabriella's article in AJVR. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
