Pneumodissection for skin protection in image-guided cryoablation of superficial musculoskeletal tumours.
OBJECTIVE
Pneumodissection is described as a simple method for preventing skin injury during cryoablation of superficial musculoskeletal tumours.


METHODS
Superficial tumour cryoablations performed from 2009 to 2015 were retrospectively reviewed. Pneumodissection was performed in 13 patients when the shortest tumour-skin distance was less than 25 mm. Indications were pain palliation (n = 9) and local tumour control (n = 4). Patients, target tumours, technical characteristics and complications up to 60 days post ablation were reviewed. The ice ball-skin distances with and without pneumodissection were compared by a paired t-test and further assessed for association with covariates using ANCOVA.


RESULTS
Technical success for ablation was 12 of 13. The mean shortest tumour-skin distance was 15.0 mm (3.2-24.5 mm). The mean thickness of pneumodissection was 9.6 mm (5.2-16.6 mm) resulting in mean elevation of skin of 3.4 mm (1.2-5.3 mm). Mean shortest ice ball-skin distance after pneumodissection was 10.5 mm (4.2-19.7 mm). No infection or systemic air embolism was noted. No intraprocedural frostbite was observed.


CONCLUSIONS
Pneumodissection is feasible, effective and safe in protecting the skin during image-guided cryoablation of superficial tumours.


CONCLUSIONS
• Frostbite during image-guided cryoablation of superficial tumours is commonly under-reported. • Frostbites are painful and may introduce infection into the superficial ablation zone. • Warm compress, saline and CO2have shortcomings in protecting the skin. • Pneumodissection is free, readily available, easy to use and safe and effective.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA. maybodym@mskcc.org.
Majid
M
Maybody
State University of New York School of Medicine and Biomedical Sciences at Buffalo, Buffalo, NY, USA.
Peter Q
PQ
Tang
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
Chaya S
CS
Moskowitz
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
Meier
M
Hsu
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
Hooman
H
Yarmohammadi
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
F Edward
FE
Boas
D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003452:Cryosurgery / Q000009:adverse effects* / Q000379:methods; D004210:Dissection / Q000379:methods*; D005260:Female; D005627:Frostbite / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
Cryoablation; Frostbite; Pneumodissection; Skin; Superficial