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Cryotherapy has been used to treat pain and inflammation since the time of Hippocrates.1 Ice, snow, cold water, and cold compresses have been used to treat a multitude of softtissue traumas.2 More recently, cryotherapy has been used increasingly in sports injuries and in the postoperative orthopedic setting.3 However, a number of complications from Cryotherapy have been reported-most commonly frostbite and peripheral nerve injury-that point out its benefits but also its dangers.1'5 These previously reported complications have been diverse in location and severity. This article reports a significant complication of Cryotherapy as a result of a relatively common regimen of application of ice packs to knees in a postoperative setting.
CASE REPORT
A 53-year-old man was referred to our microsurgery service 4 weeks after bilateral patellar tendon repair. The patient had sustained bilateral patellar tendon ruptures after a fall down his home stairs. He underwent standard patellar tendon repair through midline incisions using braided polyester suture. He had no intraoperative complications.
Postoperatively, the patient was admitted for 3 days, during which he had continuous cryotherapy with ice packs circulating cold water from an ice cooler. On postoperative day 3 he was discharged andused continuous Cryotherapy at home for an additional two weeks. The home regimen consisted of an OpSite dressing (Smith & Nephew, Largo, Fia), a paper towel interface, and the cooling pad with circulation connected to the enclosed water and ice cooler. At 2 weeks postoperatively, skin changes were noted that alerted him to see his orthopedic surgeon. At 4 weeks postoperatively he was referred for full thickness skin eschars of the bilateral knees. He was admitted for debridement, dressing changes, and wound coverage (Figure 1 ).
The patient underwent debridement of clearly nonviable tissue followed by subatmospheric pressure dressings. Further debridement and subatmospheric pressure dressings were applied on two more occasions until the wounds were clean and granulating (Figure 2). Bacterial cultures obtained at the first debridement revealed the presence of...