Cryosurgery
Effects and post treatment complications
DOI:
https://doi.org/10.35172/rvz.2017.v24.336Keywords:
cryotherapy, cryoablation, freezing, canine, felineAbstract
Cryosurgery, as known as cryotherapy or cryoablation, is a surgical technique that use
substances in cryogenic temperatures to destroy undesirable tissue and cells, mainly
neoplastic. Cellular death occurs due to short and long term freezing and thawing effect. In all
methods of surgical treatment, complications are inherent to procedure, and cryosurgery is no
exception. This paper aims to show post-treatment reaction and complications of cryosurgery
application as curative, adjuvant or palliative treatment in dogs and cats. Many changes occur
on cryosurgical treated tissue, that leads to destruction of cutaneous lesion, and tissue
response vary according to intensity and depth of cryogenic injury. Some signs, that may be
interpreted as “side effects” of cryosurgery are expected and considered normal due to
progression of freezing physiologic process. Some immediate effects are: pain, bleeding,
inflation by gas and edema; short-term effects are: blistering formation, infection, pyogenic
granuloma, and systemic reaction as fever; long-term effects are: pseudo-epiteliomatous
hyperplasia, hyperpigmentation, leucodermia, nerve damage, coat changes, natural orifices
stenosis due to scar retraction and cutaneous necrosis. Post-treatment effects depend of
freezing technique, disease process, lesion size and individual response of the patient. Despite
the side effects and complications occurrence, cryosurgery should be applied whenever
indicated, because benefits exceed that of conventional surgical technique, when correctly
executed.
References
1. Graham GF, Barham KL. Cryosurgery. Curr Probl Dermatol. 2003;15:223-50.
2. Chua KJ, Chou SK, Ho JC. An analytical study on the thermal effects of cryosurgery on
selective cell destruction. J Biomech. 2007;40:100-16.
3. Dawber RPR. Cryosurgery: complications and contraindications. Clin Dermatol.
1990;8:108-14.
4. Dewar L. Collected papers of Sir James Dewar. Cambridge: Cambridge University Press;
1927.
5. Bojrab MJ. Veterinary cryosurgery: an overview. Norden News. 1978;53:16-20.
6. Ameerally PJ, Colverg GB. Cutaneous cryotherapy in maxillofacial surgery. J Oral
Maxillofac Surg. 2007;65:1785-92.
7. Burke WA, Baden TJ, Wheeler CE, Bowdre JH. Survival of herpes simplex virus during
cryosurgery with liquid nitrogen. J Dermatol Surg Oncol. 1986;12:1033-5.
8. Jones SK, Darville JM. Transmission of virus by cryotherapy and multi-use caustic
pencils: a problem for dermatologists? Br J Dermatol. 1989;12:481-6.
9. Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37:171-
86.
10. Le Pivert P. Predictability of cryonecrosis by tissue impedancemetry. Low Temp Med.
1977;4:129-38.
11. Breitbart EW, Dachow-Siwiec E. Scientific basis. Clin Dermatol. 1990;8:5.
12. Torre D. Understanding the relationship between lateral spread of freeze and depth of
freeze. J Dermatol Surg Oncol. 1979;5:51.
13. McCarty TM, Kuhn JA. Cryotherapy for liver tumors. Oncology. 1998;12:7
14. Mazur P. Freezing of living cells: mechanisms and implications. Am J Physiol.
1984;247:125-42.
15. Reed KL, Brown TD, Conzemius MG. Focal cryogen insults for inducing segmental
ostenonecrosis: computational and experimental assessments of thermal fields. J
Biomech. 2003;36:1317-26.
16. Orpwood RD. Biophysical and engineering aspects of cryosurgery. Phys Med Biol.
1981;26:555-75.
17. Muldrew K, McGann LE. The osmotic rupture hypothesis of intracellular freezing injury.
Biophys J. 1994;66:532-41.
18. Rubinsky B. Cryosurgery. Annu Rev Biomed Eng. 2000;2:157-87.
19. Hoffmann NE, Bischof JC. The cryobiology of cryosurgical injury. Urology. 2002;60:40-
9.
20. Johnson JF. Immunologic aspects of cryosurgery: potential modulation of immune
recognition and effector cell maturation. In: Breitbart E, Dachow-Siwiec E. Clinics in
dermatology: advances in cryosurgery. New York: Elsevier; 1990. p.39.
21. Seim HB. Mechanisms of cold-induced cellular death. Vet Clin North Am Small Anim
Pract. 1980;10:755-62.
22. Ablin RJ. Current concepts in cryoimmunology. In: Zacarian SA. Cryosurgery for skin
cancer and cutaneous disorders. St Louis: Mosby; 1985. p.307-12.
23. Leopard PJ. Cryosurgery, and it’s application to oral surgery. Br J Oral Surg.
1975;13:128-52.
24. Lane JG. Practical cryosurgery: an introduction for small animal clinicians. J Small Anim
Pract. 1974;15:715-25.
25. Greiner TP, Liska WD, Withrow SJ. Cryosurgery. Vet Clin North Am Small Anim Pract.
1975;5:565-81.
26. Holmberg DL. Criocirurgia. In: Slatter D. Manual de cirurgia de pequenos animais. 3a
ed. São Paulo: Manolo; 2007. p.222-7.
27. Withrow SJ. Cryosurgery. In: Withrow SJ, MacEwen EG. Small animal clinical
oncology. 4th ed. St Louis: Saunders Elsevier; 2007. p.275-9.
28. Baust JG, Gage AA, Robilotto AT, Baust JM. The pathophysiology of thermoablation:
optimizing cryoablation. Curr Opin Urol. 2009;19:127-32.
29. Eurides D, Daleck CR, Silva LAF, Silva MSM. Criocirurgia. In: Daleck CR, De Nardi
AB, Rodaski S. Oncologia em cães e gatos. São Paulo: Roca; 2009. p.196-203.
30. Erinjeri J, Clark TWI. Cryoablation: mechanism of action and devices. J Vasc Interv
Radiol. 2010;21:187-91.
31. Keefe M, Dich DC. Cryotherapy of hand warts: a questionnaire survey of “consumers.”
Clin Exp Dermatol. 1990;15:260-3.
32. Poziomczyk CS, Koche B, Dornelles MA, Dornelles SIT. Avaliação da dor em
criocirurgia de ceratosesactinicas. An Bras Dermatol. 2011;86:645-50.
33. Graham GF. Cryosurgery for benign, premalignant and malignant lesions. In: Wheeland
RG. Cutaneous surgery. Philadelphia: Sanders; 1994. p.835.
34. Castro JLC, Silveira AMM, Castro VSP, Santalucia S, Ferreira AA, Huppes RR, et al.
Criocirurgia: revisão de literatura. Medvep Dermat. 2013;3:11-25.
35. Elton RF. Complications of cutaneous cryosurgery. J Am Acad Dermatol. 1983;8:513.
36. Lund T, Onarhei H, Wiig H, Reed RK. Mechanisms behind increased dermal inhibition
pressure in active edema. Am J Physiol. 1989;256:940-8.
37. Leappe LL. Initial changes in burns: tissue changes in burned and unburned skin of
rhesus monkeys. J Trauma. 1970;10:488-92.
38. Yoshika T, Monafo WW, Ayvazian VH, Deitz F, Flynn D. Cimetidine inhibits burn
edema formation. Am J Surg. 1978;136:81-8.
39. Mulligan MS, Till GO, Smith CW, Anderson DC, Miyasaka M, Tamatani T, et al. Role
of leukocyte adhesion molecules in lung and dermal vascular injury after thermal trauma
of skin. Am J Pathol. 1994;144:1008-15.
40. Li J, Lai-Fook SJ. Effect of hyaluronidase on interstitial pressure response to edema in
air-inflated rabbit lung. Respir Physiol. 1992;89:133-46.
41. Diess DL, Collins JN, Ardell JL, Townsley MI, Taylor AE, Ferrara JJ. Modulation of
microvascular permeability by 21-aminosteroids burn injuries. J Burn Care Rehabil.
2000;21:406-13.
42. Kuflik EG, Webb W. Effects of systemic corticosteroids on post-surgical edema and
other manifestations of the inflammatory response. J Dermatol Surg Oncol. 1985;11:464.
43. Goloubeff B, Oliveira HP. Tratamento criocirúrgico de tumores e de fístulas, em cães.
Arq Bras Med Vet Zootec.1999;51:463-70.
44. Kuflik EG. Cryosurgery for cutaneous malignancy. Dermatol Surg. 1997;23:1081-7.
45. Hancox JG, Graham GF, Yosipovitch G. Hemorrhagic bullae after cryosurgery in a
patient with hemophilia A. Dermatol Surg. 2003;29:1084-6.
46. Lucas R, Larsson CE. O uso da criocirurgia na dermatologia veterinária. Clin Vet.
2007;69:74-84.
47. Castro JC, Castro VSP, Ramos SD, Huppes R, Nardi AB, Raiser AG, et al. Criocirurgia
no tratamento de carcinoma de células escamosas em cão. Rev Colombiana Cienc Anim.
2013;5:213-21.
48. Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. J Oral
Sci. 2006;48:167-75.
49. Cecchi RM, Giomi A. Pyogenic granuloma as a complication of cryosurgery for venous
lake. Br J Dermatol. 1999;140:373-4.
50. Zacarian SA. Cryogenics: the cryolesion and the pathogenesis of cryonecrosis. In:
Zacarian SA. Cryosurgery for skin cancer and cutaneous disorders. St Louis: Mosby;
2007. p.2-3.
51. Gage AA, Meenaghan MA, Natiella JR, Greene GW. Sensitivity of pigmented mucosa
and skin to freezing injury. Cryobiology. 1979;16:348-361.
52. Zhou GY, Zhang ZY, Lin GC, Gu JZ, Qiu WL. Evaluation of cryosurgery for the
management of oral malignant mucomembranous melanoma: a survey of 107 cases
reports. Shangai Kou Qiang Yi Xue. 1999;8:92-3.
53. Lubritz RR. Cryosurgical approach to benign and precancerous tumors of the skin. In:
Zacarian SA. Cryosurgery for skin cancer and cutaneous disorders. St Louis: Mosby;
1985. p.44-8.
54. Bohler-Sommeregger K, Schuller-Petrovic S, Knobler R, Neumann PR. Reactive
lentiginous hyperpigmentation after cryosurgery for lentigomaligna. J Am Acad
Dermatol. 1992;27:523-6.
55. Kluger N, Durand L, Thoumin C, Plantier F, Cotten H, Berteloot E, et al.
Pseudoepitheliomatous epidermal hyperplasia in tattoos. Am J Clin Dermatol.
2008;9:337-40.
56. Kadunc B, Palermo E, Addorf F, Metsavaht L, Rabello L, Mattos R, Martins S. Tratado
de cirurgia dermatológica, cosmiatria e laser: da Sociedade Brasileira de Dermatologia.
Rio de Janeiro: Elsevier; 2013. p.537-54.
57. Dawber RPR. Cold kills! Clin Exp Dermatol. 1988;13:137-50.
58. Nix TW. Liquid nitrogen neuropathy. Arch Dermatol. 1965;92:185.
59. Queiroz GF, Matera JM. Criocirurgia no tratamento de tumores. Rev Educ Contin
CRMV-SP. 2004;6:53-62.
60. Shepperd JP, Dawber RPR. Wound healing and scarring after cryosurgery. Cryobiology.
1984;21:157-69.
2. Chua KJ, Chou SK, Ho JC. An analytical study on the thermal effects of cryosurgery on
selective cell destruction. J Biomech. 2007;40:100-16.
3. Dawber RPR. Cryosurgery: complications and contraindications. Clin Dermatol.
1990;8:108-14.
4. Dewar L. Collected papers of Sir James Dewar. Cambridge: Cambridge University Press;
1927.
5. Bojrab MJ. Veterinary cryosurgery: an overview. Norden News. 1978;53:16-20.
6. Ameerally PJ, Colverg GB. Cutaneous cryotherapy in maxillofacial surgery. J Oral
Maxillofac Surg. 2007;65:1785-92.
7. Burke WA, Baden TJ, Wheeler CE, Bowdre JH. Survival of herpes simplex virus during
cryosurgery with liquid nitrogen. J Dermatol Surg Oncol. 1986;12:1033-5.
8. Jones SK, Darville JM. Transmission of virus by cryotherapy and multi-use caustic
pencils: a problem for dermatologists? Br J Dermatol. 1989;12:481-6.
9. Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37:171-
86.
10. Le Pivert P. Predictability of cryonecrosis by tissue impedancemetry. Low Temp Med.
1977;4:129-38.
11. Breitbart EW, Dachow-Siwiec E. Scientific basis. Clin Dermatol. 1990;8:5.
12. Torre D. Understanding the relationship between lateral spread of freeze and depth of
freeze. J Dermatol Surg Oncol. 1979;5:51.
13. McCarty TM, Kuhn JA. Cryotherapy for liver tumors. Oncology. 1998;12:7
14. Mazur P. Freezing of living cells: mechanisms and implications. Am J Physiol.
1984;247:125-42.
15. Reed KL, Brown TD, Conzemius MG. Focal cryogen insults for inducing segmental
ostenonecrosis: computational and experimental assessments of thermal fields. J
Biomech. 2003;36:1317-26.
16. Orpwood RD. Biophysical and engineering aspects of cryosurgery. Phys Med Biol.
1981;26:555-75.
17. Muldrew K, McGann LE. The osmotic rupture hypothesis of intracellular freezing injury.
Biophys J. 1994;66:532-41.
18. Rubinsky B. Cryosurgery. Annu Rev Biomed Eng. 2000;2:157-87.
19. Hoffmann NE, Bischof JC. The cryobiology of cryosurgical injury. Urology. 2002;60:40-
9.
20. Johnson JF. Immunologic aspects of cryosurgery: potential modulation of immune
recognition and effector cell maturation. In: Breitbart E, Dachow-Siwiec E. Clinics in
dermatology: advances in cryosurgery. New York: Elsevier; 1990. p.39.
21. Seim HB. Mechanisms of cold-induced cellular death. Vet Clin North Am Small Anim
Pract. 1980;10:755-62.
22. Ablin RJ. Current concepts in cryoimmunology. In: Zacarian SA. Cryosurgery for skin
cancer and cutaneous disorders. St Louis: Mosby; 1985. p.307-12.
23. Leopard PJ. Cryosurgery, and it’s application to oral surgery. Br J Oral Surg.
1975;13:128-52.
24. Lane JG. Practical cryosurgery: an introduction for small animal clinicians. J Small Anim
Pract. 1974;15:715-25.
25. Greiner TP, Liska WD, Withrow SJ. Cryosurgery. Vet Clin North Am Small Anim Pract.
1975;5:565-81.
26. Holmberg DL. Criocirurgia. In: Slatter D. Manual de cirurgia de pequenos animais. 3a
ed. São Paulo: Manolo; 2007. p.222-7.
27. Withrow SJ. Cryosurgery. In: Withrow SJ, MacEwen EG. Small animal clinical
oncology. 4th ed. St Louis: Saunders Elsevier; 2007. p.275-9.
28. Baust JG, Gage AA, Robilotto AT, Baust JM. The pathophysiology of thermoablation:
optimizing cryoablation. Curr Opin Urol. 2009;19:127-32.
29. Eurides D, Daleck CR, Silva LAF, Silva MSM. Criocirurgia. In: Daleck CR, De Nardi
AB, Rodaski S. Oncologia em cães e gatos. São Paulo: Roca; 2009. p.196-203.
30. Erinjeri J, Clark TWI. Cryoablation: mechanism of action and devices. J Vasc Interv
Radiol. 2010;21:187-91.
31. Keefe M, Dich DC. Cryotherapy of hand warts: a questionnaire survey of “consumers.”
Clin Exp Dermatol. 1990;15:260-3.
32. Poziomczyk CS, Koche B, Dornelles MA, Dornelles SIT. Avaliação da dor em
criocirurgia de ceratosesactinicas. An Bras Dermatol. 2011;86:645-50.
33. Graham GF. Cryosurgery for benign, premalignant and malignant lesions. In: Wheeland
RG. Cutaneous surgery. Philadelphia: Sanders; 1994. p.835.
34. Castro JLC, Silveira AMM, Castro VSP, Santalucia S, Ferreira AA, Huppes RR, et al.
Criocirurgia: revisão de literatura. Medvep Dermat. 2013;3:11-25.
35. Elton RF. Complications of cutaneous cryosurgery. J Am Acad Dermatol. 1983;8:513.
36. Lund T, Onarhei H, Wiig H, Reed RK. Mechanisms behind increased dermal inhibition
pressure in active edema. Am J Physiol. 1989;256:940-8.
37. Leappe LL. Initial changes in burns: tissue changes in burned and unburned skin of
rhesus monkeys. J Trauma. 1970;10:488-92.
38. Yoshika T, Monafo WW, Ayvazian VH, Deitz F, Flynn D. Cimetidine inhibits burn
edema formation. Am J Surg. 1978;136:81-8.
39. Mulligan MS, Till GO, Smith CW, Anderson DC, Miyasaka M, Tamatani T, et al. Role
of leukocyte adhesion molecules in lung and dermal vascular injury after thermal trauma
of skin. Am J Pathol. 1994;144:1008-15.
40. Li J, Lai-Fook SJ. Effect of hyaluronidase on interstitial pressure response to edema in
air-inflated rabbit lung. Respir Physiol. 1992;89:133-46.
41. Diess DL, Collins JN, Ardell JL, Townsley MI, Taylor AE, Ferrara JJ. Modulation of
microvascular permeability by 21-aminosteroids burn injuries. J Burn Care Rehabil.
2000;21:406-13.
42. Kuflik EG, Webb W. Effects of systemic corticosteroids on post-surgical edema and
other manifestations of the inflammatory response. J Dermatol Surg Oncol. 1985;11:464.
43. Goloubeff B, Oliveira HP. Tratamento criocirúrgico de tumores e de fístulas, em cães.
Arq Bras Med Vet Zootec.1999;51:463-70.
44. Kuflik EG. Cryosurgery for cutaneous malignancy. Dermatol Surg. 1997;23:1081-7.
45. Hancox JG, Graham GF, Yosipovitch G. Hemorrhagic bullae after cryosurgery in a
patient with hemophilia A. Dermatol Surg. 2003;29:1084-6.
46. Lucas R, Larsson CE. O uso da criocirurgia na dermatologia veterinária. Clin Vet.
2007;69:74-84.
47. Castro JC, Castro VSP, Ramos SD, Huppes R, Nardi AB, Raiser AG, et al. Criocirurgia
no tratamento de carcinoma de células escamosas em cão. Rev Colombiana Cienc Anim.
2013;5:213-21.
48. Jafarzadeh H, Sanatkhani M, Mohtasham N. Oral pyogenic granuloma: a review. J Oral
Sci. 2006;48:167-75.
49. Cecchi RM, Giomi A. Pyogenic granuloma as a complication of cryosurgery for venous
lake. Br J Dermatol. 1999;140:373-4.
50. Zacarian SA. Cryogenics: the cryolesion and the pathogenesis of cryonecrosis. In:
Zacarian SA. Cryosurgery for skin cancer and cutaneous disorders. St Louis: Mosby;
2007. p.2-3.
51. Gage AA, Meenaghan MA, Natiella JR, Greene GW. Sensitivity of pigmented mucosa
and skin to freezing injury. Cryobiology. 1979;16:348-361.
52. Zhou GY, Zhang ZY, Lin GC, Gu JZ, Qiu WL. Evaluation of cryosurgery for the
management of oral malignant mucomembranous melanoma: a survey of 107 cases
reports. Shangai Kou Qiang Yi Xue. 1999;8:92-3.
53. Lubritz RR. Cryosurgical approach to benign and precancerous tumors of the skin. In:
Zacarian SA. Cryosurgery for skin cancer and cutaneous disorders. St Louis: Mosby;
1985. p.44-8.
54. Bohler-Sommeregger K, Schuller-Petrovic S, Knobler R, Neumann PR. Reactive
lentiginous hyperpigmentation after cryosurgery for lentigomaligna. J Am Acad
Dermatol. 1992;27:523-6.
55. Kluger N, Durand L, Thoumin C, Plantier F, Cotten H, Berteloot E, et al.
Pseudoepitheliomatous epidermal hyperplasia in tattoos. Am J Clin Dermatol.
2008;9:337-40.
56. Kadunc B, Palermo E, Addorf F, Metsavaht L, Rabello L, Mattos R, Martins S. Tratado
de cirurgia dermatológica, cosmiatria e laser: da Sociedade Brasileira de Dermatologia.
Rio de Janeiro: Elsevier; 2013. p.537-54.
57. Dawber RPR. Cold kills! Clin Exp Dermatol. 1988;13:137-50.
58. Nix TW. Liquid nitrogen neuropathy. Arch Dermatol. 1965;92:185.
59. Queiroz GF, Matera JM. Criocirurgia no tratamento de tumores. Rev Educ Contin
CRMV-SP. 2004;6:53-62.
60. Shepperd JP, Dawber RPR. Wound healing and scarring after cryosurgery. Cryobiology.
1984;21:157-69.
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2017-03-31
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Malburg C, Gonzalez Peres Albernaz V, Costa Castro JL. Cryosurgery: Effects and post treatment complications. RVZ [Internet]. 2017 Mar. 31 [cited 2024 Jul. 3];24(1):35-48. Available from: https://rvz.emnuvens.com.br/rvz/article/view/336
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