cryopen?

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hi,

i am hoping to evaluate the use of our new cryotherapy tool. i have been using the 'cryopen' for treatment of verrucae and wondered about other practitioners success/failures with this tool. i have read the guidelines using the cryopen but wondered if anyone has been using a different technique. i would be interested in the duration of freeze, number of freeze/thaw cycles used in any one session and how many applications practitioners apply before determining its success. also whether you recommend combining treatment modalities.

i have found that patients are tolerant of this treatment but this week alone have had 3 patients question whether it should hurt to gain a successful outcome...slightly perverse but an understandable laymans thought process i think!

hoping some of you can shead some light on this?

thanks
poppet

 

Hello Poppet,

I use the cryopen quite a lot. I tend to use two cylinders per application, with thawing in between. The technique I employ is to use the grey tip and hold it as close to the lesion as possible , moving the ice out of the way as it builds up, but watching my bare arms, as it splutters a lot !! I find that it is essential to get the quickest, deepest freeze that the patient can tolerate. Applying salicylic acid a week before can be helpful. You will find with practise what works best for you.

Hope this helps

 

thanks for the reply Nigel...i have also found that it splutters icicles, i use the tip very near the leasion also and am finding that i am getting some possitive results by increasing the length of time for freezes. i was concerned about applying the freeze for too long and doing damage so i think that i was being a little over cautious to begin with. i dont use the SA before but i do debride the VP site as much as possible so that the cryo 'can do its stuff' to the affected area rather than any overlying callus. 2 cylinders per application sounds alot as the freeze time i am getting for each one is up to 2mins? this is a query rather than a critisism by the way

cheers

poppet

 

Hu

The cryopen, in my opinion, is only effective on dorsal warts/verrucae. It is of little use on plantar surfaces as it cannot penetrate deeply enough. I think it is very expensive for what it is and relies on a cryogen which is not as effective as nitrous oxide.

You should think hard about buying one. The refills are expensive too.

Not impressed and I teach cryosurgery.:empathy::empathy::empathy:
u

 

hi Medisrch,

i hope my response comes across as it is intended but... is your opinion of the cryopen as a result of theroetical knowledge or have you gained this opinion of this tool because you have used it in practice? i am genuinly interested in finding out as it gives a broader view of others experiences with cryo tools. i have begun to see improved responses using the cryopen although i agree it is an expensive outlay the refills arent too costly IMO...but then i am new to PP so am reletively naive about costs

thanks for the response and look forward to hearing more

poppet

 

Hi Medisrch,

I bow to your knowledge of cryosurgery and the teaching of it ; however, in my experience of using it, if you keep the probe in contact with the lesion for the duration of two cylinders, you can achieve a significant cryogenic burn which will deal with plantar vps . Just my own observations and outcomes.

Nigel

 

Hi Poppet et al

It is from my own experience in clinics which now treat some 14000 patients per annum many of which are verrucae. I am a great believer in cryo and my only comment is directed to the cryopen. I use the usual probes from the E or F type cylinders. Hope this is helpful.

 

G'day all....

Just out of curiousity, I haven't had any experience with the cryopen, but use liquid nitrogen quite frequently. I've found that if one adds extra cotton wool to the cotton applicator, it picks up much more liquid nitrogen and gives a better freeze. Just cuious as to advantages in terms of cost and versatility of cryopen vs liquid nitrogen? I know the liquid nitrogen requires a big canister, but once on a trolley it is quite easily moved around.

Cheers!

 

Hi

I tried the cryopen out as it was sent to me for trial and whilst I found it effective on dorsal verrucae on the hands and feet it was not effective on the plantar - deep seated verrucae.Perhaps we get some of the worst cases for miles around but agree that liquid nitrogen is most effective but storage is a worry and patients look aghast at vapour.

Regards

 

hi all,

thanks again for the interesting replies on this.

adrian, in reply to your question on advantages...for us it was simply a look at other hand held devices (which i stuggled to find any others that had better anecdotal evidence on), the fact that we are a small clinic practicing in 2 locations so wanted something that can be transferred between clinics and home visits in needed and finally, that whole thing of patient approval.

i totally agree that liquid nitrogen is far better in treating VP's but for us the cryopen was a compremise.

i hope that anyone else using the cryopen or indeed any other VP tt methodology can add to this thread...very interesting stuff.

thanks

poppet

 

hi all and a happy new year to you all!

just thought i would update you on my cryopen success...using nigel's method of 2 cartridges per application, i then brought patients back 1 week later to sharp debride the VP. i have had 3 out of 4 patients that have had success with this method; the 4th had 5 VP's and only 2 remain and require a repeat treatment. the wound left following treatment is cleaned, covered with a dry dressing and the area is offloaded with SCF for comfort. patients are happy that this is now successful...and so patients will return, talk to other prospective patients which is good for my PP

poppet

 

Yes I used it when it was first launched and so speak from personal experience of it. I have some refills left too.

 

Hi:

Good thread.
So, Poppit, you are using 2 cartridges/lesion as suggested and obtaining good results. 2 cartridges (around 4 minutes) eradicated 4 or 5 warts that you treated? Very good.
Were these all Plantar? Adults, kids? Can I ask the size of the lesions?
Do you anesthetize them?

Steve

 

hi Steve,
glad you like the thread. in answer to your queries; most were on adults, however, i have treated a child (aged 10 and had antalgic gait due to VP pain) who i used 2 x 60 sec freeze-thaw cycle. week 2 showed good results and week 3 i debrided some overlying callus and VP gone

sizes are mostly small ranging from around 3 - 6mm in diameter. i do have one new mosaic VP which is 1.6cm diameter on the base of the hallux. i contemplated using 2 x 2min cartridges but given the locality i opted (i hope rightly considering our hippocratic oath!!!) for a more cautious treatment of 2 x 60 sec freeze/thaw cycles. given the size, i still had to use more than one cartridge as i had to apply in 3 sections. i am yet to use the other nozzle that came with the cryopen so i may try this on this patients next appointment if it is required.

sites have on the whole been plantar but i have also had one on the lateral boarder.

i have treated quite a few now and it seems the more agresive i am the better results i get (taking in consideration of course the afformentioned issues).

in addition to the use of the cryopen i debride (prior to treatment) all the macerated tissue i possibly can. i then ask the patients to keep the VP sites covered with duct tape (given the evidence base for this now!). this also helps patients to keep up personal hygine and avoid cross contamination when bare foot - patients appreciate this - i had one young lady recently who was going out to a 'do' one evening and didnt want the unsightly duct tape showing so i suggested that she used enough to cover the plantar heel area (vp location) and gave her some hapla tape (if you are unfamiliar with this it is kind of flesh coloured!) to place over this in the same template and thus little chance of the duct tape showing - another happy patient (oh smug was i).

finally, i dont anesthetize as a rule ut if there was a clinical need (i.e. a patient was in pain and all other treatments had been exhausted or eliminated) then yes, i could and would anesthetize. i do advise that patients may experience some post treatment pain - in particular over the following 24-36hrs and they should use their usual pain relief.

i have had one patient who i thought the VP had gone but this has come back. this is as yet the only one but my failures are as much of the learning process as my successes i think.

i hope all this helps add to whats already been put forward? what expereinces have you had with VP tt modalities. do you have any additional thoughts?

regards
poppet

 

Hi Poppet:
Very informative and thank you for taking the time to explain your procedure.
I've been looking for an alternative to Chemodestruction or surgical currettage and perhaps the cryopen fits the bill.

Thank you

Steve

 

Hi

Thanks for this informative thread. I've recently started a PP after years of NHS and have patients with VPs. Have been treating this with vary degree of success with silver nitrate. At the moment I have a cryopen which i am trying out. Would like to know if anyone has found a cheaper source of the 8g N2O cartridges. Is the Cryopen worth the outlay?

Thanks

Rachael

 

hi Rachael,

i still really like the cryopen. i personally think it is worth the outlay as it is so user and pt friendly comapred to other tt for VP's. i agree the outlay is expensive and i would also like to hear if anyone nows where to get cheaper cartidges...any idea's pods?

i am sure i am not the only one who would like to hear more anecdotal evidence with this peice of equipment so anyone else having good or bad results with this please let us know!

thanks

poppet

 

Poppet

Slightly concerned that if cryopen they stop making the 8g cartridges as buying the older style as smaller and lighter to use. Been given price of £460. Had some sucess re silver nitrate but takes along time. Could really do with more advice but research not going well re VP's. Think podiatry schools need to do more teaching on this! NHS trusts I worked for didn't really treat VP's.

Thanks anyway

Rachael

 

hi Rachael,

i agree with your concerns ...can't really comment much more on that point.

have you also seen the thread i started on mosaic verrucae's...some very interesting stuff...yet to try this myself but hope to...

poppet