Biomedical subjects
Publications and source records attributed to B M Achauer.
This case report details the successful treatment of extensive, facial traumatic tattooing in an adult male. The Q-switched ruby laser was utilized. It is demonstrated to be an excellent tool for the treatment of traumatic tattooing. The results achieved are superior to other methods and complications reported with other treatment options are minimized.
The Q-switched ruby laser at 694 nm, a wavelength well absorbed by melanin relative to other optically absorbing structures in skin, causes highly selective destruction of pigment-laden cells. In addition, the 20- to 40-ns pulse duration produced by this laser approximates the thermal relaxation time for the melanosomes, thereby confining the energy to the target. The Q-switched ruby laser was used to treat 47 patients (11 males and 36 females) with nevus of Ota during the period December 1991 to 1994. The involved facial area ranged from 3 x 3 cm2 to 20 x 20 cm2. The energy fluence used varied from 8 to 10 J/cm2, and the number of treatments ranged from 1 to 8 (mean 3.4). The results were graded on the basis of cleaning and fading as follows: poor (0 to 25 percent), fair (26 to 50 percent), good (51 to 75 percent), and excellent (76 to 100 percent). The mean follow-up period was 15 months. Poor and/or fair results were found in 8 patients who received one treatment and 7 patients who had two treatments. Good results were seen in 1 patient who had two treatments, 7 patients who received three treatments, and 3 patients who had four treatments. Twenty-one patients had excellent results after three or more treatments of the whole lesion. In conclusion, this laser system produces clinically significant fading of nevus of Ota in patients without complications such as hypertrophic scarring or permanent changes in the normal skin pigmentation.
A retrospective study of 73 patients treated for symptomatic hemangiomas of head and neck from May 1981 to April 1994 was conducted. Fifty-three females and 20 males ranging in age from 1 day of life to 11 years with the average age being 19 months were reviewed in the University of California, Irvine Medical Center. All patients were referred by pediatricians or family practitioners for evaluation and possible laser treatment. The lesions reported were particular troublesome because of obstruction of orifice(s), repeated ulceration, bleeding, subsequent pain or life threatening. Various lasers have been used for these patients including: CO2 laser [10], Argon laser/with intralesional steroid injection [33/14], Nd YAG laser [21], KTP laser [1] and Flashlamp-pumped pulsed dye laser (FPPDL)[8]. All treated lesions healed in 7 to 21 days (mean, 12 days). Complications associated with laser treatment, such as postoperative bleeding and infection were not seen. The symptoms were totally relieved from 7 days to 24 months (mean, 9 months). Combined with reconstructive surgery, the texture changes (7 patients) after laser treatment were corrected successfully. The outcome was graded by reduction in volume, improvement of color and texture of hemangioma as follow: Grade 1 - Poor (0-25%); Grade II - Fair (26-50%); Grade III - Good (51-75%); Grade IV - Excellent (76-100%). The final results of the patients are similar to what may be expected after spontaneous involution of a complicated hemangioma. In summary, complicated hemangiomas of head and neck in infancy have significant morbidity that can be efficiently avoided with the use of laser therapy.
Evaluation and treatment of the contralateral breast is an integral component of the reconstructive process. Communication and planning with the patient in regards to management of the CB will maximize the reconstructive result and patient satisfaction.
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This case report documents the treatment of extensive vitiligo with melanocytic grafting using ultra-thin, split-thickness skin grafts. Results, limitations, and disadvantages are discussed.
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The Q-switched ruby laser is currently used in the treatment of amateur and professional decorative tattoos. The present study documents the clinical management and follow-up of 12 subjects with traumatic tattoos treated with the Q-switched ruby laser. The results of this study indicate that an excellent clinical outcome can be achieved with substantial removal of the targeted foreign pigmented matter while potential adverse effects are significantly reduced. Hypopigmentation, which occurred in four patients (33.3 percent), was temporary and resolved spontaneously in all subjects within 6 months of laser exposure. There was no hypertrophic scarring, atrophy, or induration seen in any of the subjects treated with the Q-switched ruby laser.
Successful management of the pediatric patient is a challenge to plastic surgery nurses as they work in tandem with surgeons to guide the family through the treatment process. This article will discuss the treatment of a number of congenital birthmarks, specifically congenital vascular birthmarks and congenital nevi, which have a potential for malignant transformation.
A national survey was conducted concerning methods used for the evaluation of velopharyngeal function with emphasis on the role of nasendoscopy. Forty-five percent of questionnaires were returned. Ninety percent of the responding teams indicated that nasendoscopy was available. Sixty-one percent agreed that endoscopy was an important clinical tool and not solely a research tool. The majority (59%) considered 3 to 5 years of age to be the youngest, appropriate age for referral. Ninety percent agreed that nasendoscopy was indicated for difficult diagnostic problems and 41% reported endoscopic studies were appropriate for all patients for whom secondary palatal management is planned. The results of this survey suggest that endoscopic assessment of velopharyngeal function is used routinely as an adjunct to the perceptual evaluation of speech and has become the standard of care among cleft palate teams for difficult diagnostic cases. However, the data also indicate that increased availability does not necessarily assure optimal use.
A retrospective review of 134 patients who received laser therapy with the pulsed-dye laser at the 585-nm wavelength for capillary vascular malformations was conducted. These patients were treated over a 5-year period with a minimum follow-up of 2 years. Ninety-five patients were available for evaluation of results. Thirty-nine were lost to follow-up. Each birthmark was described before and after treatment under a classification system developed by the authors. Results were reported by classification, age, anatomic location, and race. Excellent or good results were obtained in the majority of patients in all age groups and regardless of the color of the birthmark. All anatomic areas and all ethnic groups responded to treatment with varying degrees of success. A range of up to eight treatments was required to achieve resolution. Scarring was an infrequent complication (1.1 percent) of treatment. Hypopigmentation was seen in 3.2 percent of treated patients. The pulsed-dye laser (585 nm) offers promise to patients of all ages and hope to those who previously were not candidates for laser therapy.
Most cutaneous vascular abnormalities can be successfully, and in fact preferentially, treated with lasers. The field is evolving rapidly. It is important that the appropriate laser be used. In addition, many of the early references in this field are quite out of date. We are treating lesions at a much earlier age and our expectations are much higher. We expect the result to be virtually normal-looking skin with complete resolution of the problem. Capillary vascular malformations (port wine stain) are the most frequent indication for laser treatment in both children and adults. With the advent of the flashlamp pumped pulsed dye laser, these lesions can be treated in infancy and early childhood. This represents a significant breakthrough, because unlike with previous lasers, scarring is a rare side effect of treatment with yellow light lasers. The psychologic trauma of growing up with a facial deformity can be minimized with early treatment. It is hoped that the hypertrophy and permanent deformity associated with these lesions can be mitigated. The various lasers currently available to the plastic surgeon provide treatment options not previously available. Lasers are expected to play an increasing role in cutaneous abnormalities in the field of plastic surgery.
The priorities, timing, techniques, and philosophies of reconstruction of the burned face are outlined in this article. Each anatomic area is analyzed, and the appropriate procedure is described.
Ten female infants were referred for symptomatic hemangiomas in the anogenital area. (One had had steroid treatment prior to consultation.) The natural history of these lesions is well known. Virtually all will spontaneously involute over a period of years. However, the lesions reported were particularly troublesome because of repeated ulcerations and subsequent pain. Prior treatment had been local wound care with antibiotic ointment and Telfa-type dressings. After referral from a family practitioner or pediatrician, argon laser treatment was performed in an outpatient setting. Eight of the 10 patients were treated with local anesthesia, and 2 had general anesthesia. All lesions healed in 1 to 5 weeks. No patients referred during this period were excluded from this series. All who received treatment were included. All the lesions involuted following treatment. In our estimation, the final result is identical to what may be expected after spontaneous involution of an ulcerated or infected hemangioma. The major difference is that involution occurred in a few weeks in laser-treated patients rather than a period of months or years. Ulcerated hemangiomas of the anogenital area have significant morbidity that can be efficiently avoided with the use of argon laser therapy. Lesions of the anogenital area have a strong predilection for females.